Contrast medium-associated renal dysfunction in patients with cirrhosis


Contrast Medium-Associated Renal Dysfunction in Patients With Cirrhosis


We appreciate the comments of Huo et al. related to our recent study in which we investigated the effect of contrast media on renal function in patients with cirrhosis.1 The main finding of our study was that the administration of contrast media was not associated with adverse effects on renal function in patients with cirrhosis; thus suggesting that cirrhosis is not a risk factor for contrast media–induced nephrotoxicity. Huo et al. are not in agreement with our conclusion. The main reason for the disagreement comes from the results of a recent study in which these authors observed a 6.6% incidence of acute renal failure in a large series of patients with cirrhosis and hepatocellular carcinoma treated with transarterial chemoembolization (TAE).2 However, in our opinion, TAE is not a good model to assess changes in renal failure due to contrast media. In fact, TAE may be associated with a number of complications that can result in acute renal failure, such as postembolization syndrome, bacterial infections, ischemic hepatitis, and liver failure. Therefore, the conclusion that changes in renal failure in patients treated with TAE are due to the contrast media is not legitimate. The approach used in our study to evaluate nephrotoxicity due to contrast media (i.e., to assess renal function after administration of contrast media for diagnostic radiological procedures) seems to be the best approach possible, because renal function is not affected by confounding factors. In fact, this approach has been used for years in studies assessing contrast media–induced nephrotoxicity.3–5

Mónica Guevara*, Gloria Fernández-Esparrach*, Pere Ginès*, * Hospital Clinic — Liver Unit, Barcelona, Spain.