Low risk of contrast media-induced acute renal failure in nonazotemic type 2 diabetes mellitus

Diabetes mellitus afflicts about 10 million Americans and appears to be increasing at the rate of 6% per year. Bergman, Ellison, and Dunea [1] initially reported the occurrence of acute renal failure in a diabetic patient after infusion urography. Since that time, at least 122 insulin-dependent (type 1) and maturity onset (type 2) diabetic patients who developed deterioration of renal function after contrast media study have been reported [1–21]. Among these 122, 70 patients (57.3%) evidenced renal dysfunction following intravenous urography (IVU). Sixty-four (91%) of these 70 patients had a serum creatinine concentration equal to or more than 2 mg/dl, while six had a level below 2 mg/dl before receiving contrast media. Of the other 52 diabetic patients who developed renal failure following other contrast media studies [aortography, selective angiography, intravenous cholangiography, and CAT scanning] 12 (23%) had a serum creatinine concentration less than 2 mg/dl prior to the study. Thus, of 122 patients developing contrast media-induced renal failure, 18 (15%) had serum creatinine concentrations below 2 mg/dl. A serum creatinine concentration of 2 mg/dl was selected for analyzing prior reports to exclude minor creatinine elevations due to diuretics or transient dehydration. To ascertain whether or not diabetic patients with apparent good renal function face an increased risk of renal dysfunction from exposure to contrast media, a prospective study was performed in 49 type 2 diabetic patients with serum creatinine less than 2 mg/dl who were to undergo IVU.