The effect of radiological contrast media on renal function and inflammatory markers in people with diabetes – a clinical study and review


  • Mark Baxter Department of Medicine, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
  • Catherine Gooday Diabetic Foot Clinic, Elsie Bertram Diabetes Centre, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
  • Ketan Dhatariya Department of Medicine, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK; Diabetic Foot Clinic, Elsie Bertram Diabetes Centre, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK



Aim: To assess the association of inflammatory markers and the risk of developing contrast-induced nephropathy (CIN) in patients with diabetes undergoing lower limb angiography.

Methods: This was a retrospective study of 77 patients undergoing lower limb angiography. We measured renal function and markers of inflammation, in particular neutrophil and lymphocyte count and C-reactive protein (CRP) levels, before and at 24, 48 and 72 hours after administration of contrast medium.

Results: Those with pre-existing renal disease were at increased risk of CIN. We found no relationship between baseline renal function and CRP. There was a reduction in haemoglobin and lymphocyte count that is currently unexplained.

Conclusions: While several traditional risk factors for CIN have been identified, further work is needed to determine the significance of changes in other haematological parameters.


Barrett BJ, Parfrey PS. Prevention of nephrotoxicity induced by radiocontrast agents. N Engl J Med 1994;331:1449-50.

Tublin ME, Murphy ME, Tessler FN. Current concepts in contrast media-induced nephropathy. Am J Roentgenol 1998;171:933-9.

Mehran R, Nikolsky E. Contrast-induced nephropathy: Definition, epidemiology, and patients at risk. Kidney Int 2006;69:S11-15.

Renal Association, Royal College of Radiologists, and British Cardiovascular Intervention Society. Prevention of contrast induced acute kidney injury (CI-AKI) in adult patients. 2013. Available at (last accessed June 29 2015).

Gallagher S, Knight C. Contrast-induced nephropathy in primary percutaneous coronary intervention. Heart 2011;97:1723-5.

Russo D, Minutolo R, Cianciaruso B, et al. Early effects of contrast media on renal hemodynamics and tubular function in chronic renal failure. J Am Soc Nephrol 1995;6:1451-8.

Mehran R, Ayming ED, Nikolsky E, et al. A simple risk score for prediction of contrast-induced nephropathy after percutaneous coronary intervention. J Am Coll Cardiol 2004;44:1393-9.

Gleeson TG, Bulugahapitiya S. Contrast-induced nephropathy. Am J Roentgenol 2004;83:673-89.

McCullough PA, Wolyn R, Rocher LL, et al. Acute renal failure after coronary intervention: Incidence, risk factors, and relationship to mortality. Am J Med 1997;103:368-75.

Evola S, Lunetta M, Macaione F, et al. Risk factors for contrast induced nephropathy: A study among Italian patients. Indian Heart J 2014; 64:484-91.

Liu Y, Tan N, Zhou Y-L, et al. High-sensitivity C-reactive protein predicts contrast-induced nephropathy after primary percutaneous coronary intervention. J Nephrol 2012;25:332-40.

Schwedler SB, Kuhlencordt PJ, Ponnuswamy PP, et al. Native C-reactive protein induces endothelial dysfunction in ApoE -/- mice: Implications for iNOS and reactive oxygen species. Atherosclerosis 2007;195:e76-84.

Haffner SM. Insulin resistance, inflammation, and the prediabetic state. Am J Cardiol 2003;92:18-26J.

Royal College of Radiologists. Metformin: Updated guidance for use in diabetics with renal impairment. 2009 (last accessed June 29 2015)

Persson PB, Tepel M. Contrast medium-induced nephropathy: The pathophysiology. Kidney Int 2014;69:S8-10.

Persson PB, Hansell P, Liss P. Pathophysiology of contrast medium-induced nephropathy. Kidney Int 2005;68:14-22.

Deray G, Martinez F, Cacoub P, et al. A role for adenosine calcium and ischemia in radiocontrast-induced intrarenal vasoconstriction. Am J Nephrol 1990;10:316-22.

Hall KA, Wong RW, Hunter GC, et al. Contrast-induced nephrotoxicity: The effects of vasodilator therapy. J Surg Res 1992;53:317-20.

Parfrey PS, Griffiths SM, Barrett BJ, et al. Contrast material-induced renal failure in patients with diabetes mellitus, renal insufficiency, or both. N Engl J Med 1989;320:143-9.

Lautin EM, Freeman NJ, Schoenfeld AH, et al. Radiocontrast-associated renal dysfunction: incidence and risk factors. Am J Roentgenol 2014; 57:49-58.

Rihal CS, Textor SC, Grill DE, et al. Incidence and prognostic importance of acute renal failure after percutaneous coronary intervention. Circulation 2002;105:2259-64. 0000016043.87291.33

Lasser EC, Lyon SG, Berry CC. Reports on contrast media reactions: analysis of data from reports to the U.S. Food and Drug Administration. Radiology 1997;203:605-610.

Nikolsky E, Mehran R, Turcot D, et al. Impact of chronic kidney disease on prognosis of patients with diabetes mellitus treated with percutaneous coronary intervention. Am J Cardiol 2004;94:300-05.

Kwasa EA, Vinayak S, Armstrong R. The role of inflammation in contrast-induced nephropathy. Br J Radiol 2014;87:20130738.

Kaya A, Kurt M, Tanboga IH. Neutrophil-to-lymphocyte ratio predicts contrast-induced nephropathy in patients undergoing primary percutaneous coronary intervention. Angiology 2014;65:59.

Mansi IA. In vitro effects of coronary angiography: Unknown clinical implications. Med Hypotheses 2009;73:389-92.

Feldman LJ, Chollet-Martin S, Himbert D, et al. Modulation of the expression of the granulocyte adhesion molecule, CR3, by percutaneous transluminal coronary angioplasty and contrast media. Invest Radiol 1994;29:313-18.

Antunez C, Barbaud A, Gomez E, et al. Recognition of iodixanol by dendritic cells increases the cellular response in delayed allergic reactions to contrast media. Clin Exp Allergy 2011;41:657-64.

Gomez E, Ariza A, Blanca-Lopez N, et al. Nonimmediate hypersensitivity reactions to iodinated contrast media. Curr Opin Allergy Clin Immunol 2013;13:345-353.

McClellan W, Aronoff SL, Bolton WK, et al. The prevalence of anemia in patients with chronic kidney disease. Curr Med Res Opin 2004;20:1501-10.

Morabito S, Pistolesi V, Benedetti G, et al. Incidence of contrast-induced acute kidney injury associated with diagnostic or interventional coronary angiography. J Nephrol 2012;25:1098-107.

Idee JM, Beaufils H, Bonnemain B. Iodinated contrast media-induced nephropathy: pathophysiology, clinical aspects and prevention. Fundamental & Clinical Pharmacology 1994;8:193-206.






Current Topics

Most read articles by the same author(s)

1 2 > >>