ESRD Patients are exposed to the risk of ionizing radiation during repeated imaging studies (NDT 29:680; 2014). However, the issue is still sparsely investigated and the variability in diagnostic imaging policies in various Renal Units is still unknown. We studied the variability of application of medical imaging with ionizing radiation at center level and quantified the associated risks at patient level. We estimated the organ doses (HT) involved and applied the organ specific cancer mortality data [Risk of exposure-induced cancer death (%) (REID)].
Fourteen Italian nephrology departments enrolled 739 HD and 486 Tx patients and recorded the details of the radiological procedures performed over one year. HT estimates were derived for each specific (radiological or radionuclide imaging) procedure using a standard and reliable software and algorithms
In the combined population the average REID was 0.047±0.12 % and the corresponding 5-years cancer risk attributable to ionizing radiation exposure was 1 every 424 patients. The median REID was 0.009% and the 3rd quartile was 0.03%. The average REID was significantly higher in HD than in Tx patients (0.06±0.13 i.e. 1:333 patients for 5-years vs 0.03±0.09 i.e. 1:666 patients for 5-years; p<0.001), respectively. The variation of average REID among participating centers was highly significant (F=3.23; p<0.001) ranging from a minimum of 0.009% to a maximum of 0.09% denoting substantially different imaging policies among participating centers.
The excess cancer risk attributable to medical exposure to ionizing radiation is not negligible and is highly variable among different centers (a tenfold variation), suggesting that protocols of individual patient’s follow up with medical imaging using ionizing radiation are far from being standardized. On average, transplant patients have a lower exposure than HD patients, suggesting that kidney transplantation reduces the application imaging studies and the ensuing risk of exposure to ionizing radiation.
