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F A C U L T Y O F H E A L T H S C I E N C E S
U N I V E R S I T Y O F C O P E N H A G E N
Measurement of eGFR before contrast-enhanced CT
Rikke Norling, MD; Helle Baadsgaard Kaulberg; Martin Lundsgaard Hansen, MD; Henrik S Thomsen, MD, DMSc. Department of Diagnostic Radiology, Copenhagen University Hospital Herlev, Denmark
From all high-risk patients without a valid serum
The risk of Contrast Induced Nephropathy (CIN)
creatinine, both s-creatinine and eGFR were
which rate the public Danish health services.
increases with decrease in renal function.
obtained on-site by means of a point-of-care unit
The rate for a CT examination ranges from 187
Measurement of renal function can be obtained
(POC) Stat Sensor®. These high-risk patients are
Euro to 465 Euro. In this study, we have
by an estimated Glomerular Filtration Rate
denoted POC-patients (n=39). The eGFR was
applied the average price for a CT examination
(eGFR). In patients with increased risk of
calculated by means of the Modification of Diet in
(326 Euro). Other expenses related to the POC
impaired renal function, The European Society
Renal Disease (MDRD) formula (1). POC-patients
procedure are: StatSensor® (5.347 Euro), Test
of Urogenital Radiology (ESUR) has with an eGFR >45mL/min/1.73m² underwent the
recommended measurement of eGFR within 7
planned contrast–enhanced CT examinatio
n. Once installed only few expenses are related
However, for diabetic patients in metformin treatment
to the POC unit. Minor expenses are kept out
the threshold is an eGFR >60 ml/min/1.73m². The
limits of eGFR >45mL/min/1.73m² and >60
examinations using contrast-enhanced CT are
ml/min/1.73m² is based on recent studies which
1126 patients were referred to a non-acute CT
postponed. Consequently, patients experience
conclude there is a low risk of CIN with eGFR >40
examination during the one month investigation
department suffers from inexpedient expenses
measurement procedure, 39 examinations in
patients at high risk for CIN were performed
despite an invalid eGRF at referral. About 3 %
In the present study we aimed at evaluating if a
quick on-site measurement of eGFR in patients
postponed. Cost-benefit analysis in table 2.
at risk for CIN but without valid eGFR could
We registered all patients who were referred to
the Radiological Department, Herlev University
Table 2. Estimated expenses and revenues during a one month period. Amounts in Euro.
Hospital for a non-acute contrast-enhanced CT
examination during a one month period (July-
August 2009). High-risk for CIN was assessed
Applied to the Radiological department in
Figure 1. On-site eGRF measurement.
approximately 3% by using a POC unit for on-
site creatinine measurement. The expenses
High risk for CIN:
for the POC and test materials is readily
analysis based on estimated expenses of our
covered after one month. Moreover, there are
radiological department. In Denmark all citizens
obvious clinical advantages for the patients.
Finally, saving patients form re-referral on-site
• Concurrent administration of nephrotoxic drugs
examination is free of charge for the patient if
creatinine measurement also has potential
the examination is subscribed by an authorized
High risk for raised serum creatinine:
medical doctor. The price for a CT examination
is determined by The Danish national board of
health (Sundhedsstyrelsen) according to the
Diagnosis-Related-Groups (DRG) and Dansk
departments subjected to public national
health services similar to the Danish system.
Table 1. ESUR Guidelines for high risk for CIN
The StatSensor and the test strips were provided free-of-charge
1. Levey AS et al., 1999 Ann Intern Med.
by www.bracco.com to the Radiological Department at Herlev
2. Nyman U et al., 2005 Acta Radiol.
Hospital. The company was not otherwise involved in the
3. Thomsen HS and Morcos SK., 2009 Eur Radiol.
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