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 Background
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- Conclusion
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 References
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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