Risk of Intravenous Contrast Material-mediated Acute Kidney Injury: A Propensity Score-matched Study Stratified by Baseline-estimated Glomerular Filtration Rate
Risk of Intravenous Contrast Material-mediated Acute Kidney Injury: A Propensity Score-matched Study Stratified by Baseline-estimated Glomerular Filtration Rate
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DOI：
10.1148/radiol.13130775
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发表时间：
2014-04-01
期刊：
影响因子：
19.7
通讯作者：
Williamson, Eric E.
中科院分区：
文献类型：
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作者：
McDonald, Jennifer S.;McDonald, Robert J.;Williamson, Eric E.
为了确定基线估计肾小球滤过率(EGFR)对静脉注射含碘造影剂与随后发生急性肾损伤(AKI)之间的因果关系的影响，在接受对比剂增强或平扫的倾向评分匹配的患者组中。这项回顾性研究符合HIPAA标准，并获得机构审查委员会的批准。所有在2000-2010年间接受增强扫描(造影剂组)或平扫(非造影剂组)的患者根据基线的EGFR进行识别和分层，使用慢性肾脏疾病的肾脏疾病预后质量倡议界值，将其分为EGFR大于或等于90、60~89、30~59和小于30毫升/分钟/1.73米(2)的亚组。在每个EGFR亚组中进行倾向评分生成和患者1：1匹配。通过Fisher精确检验比较匹配亚组中AKI的发生率(血肌酐[Scr]较基线升高0.5 mg/dL[>；=44.2Mol/L])。共有12508名倾向评分匹配的患者接受增强扫描和平扫，符合所有纳入标准。在这个以住院患者为主的队列中，AKI的发生率随着基线EGFR的降低而显著增加(P<；.0001)。对比剂的OR值为0.91(95%可信区间：0.38，2.15)，P=.82；对比剂的OR值为1.03(95%CI：0.66，1.60)，P=0.99；对于EGFR在30~59之间的亚组(n=5510)，OR为0.94(95%CI：0.76，1.18)，P=0.65；对于EGFR<30mL/min/1.73m2的亚组(n=1486)，OR为0.97(95%CI：0.72，1.30)，P=0.89。然而，AKI的风险与造影剂暴露无关，即使在EGFR小于30mL/min/1.73m2的患者中也是如此。(C)RSNA，2013年
To determine the effect of baseline estimated glomerular filtration rate (eGFR) on the causal association between intravenous iodinated contrast material exposure and subsequent development of acute kidney injury (AKI) in propensity score-matched groups of patients who underwent contrast material-enhanced or unenhanced computed tomography (CT).This retrospective study was HIPAA compliant and institutional review board approved. All patients who underwent contrast-enhanced (contrast material group) or unenhanced (non-contrast material group) CT between 2000 and 2010 were identified and stratified according to baseline eGFR by using Kidney Disease Outcomes Quality Initiative cutoffs for chronic kidney disease into subgroups with eGFR of 90 or greater, 60-89, 30-59, and less than 30 mL/min/1.73 m(2). Propensity score generation and 1:1 matching of patients were performed in each eGFR subgroup. Incidence of AKI (serum creatinine [SCr] increase of >= 0.5 mg/dL [>= 44.2 mu mol/L] above baseline) was compared in the matched subgroups by using the Fisher exact test.A total of 12 508 propensity score-matched patients with contrast-enhanced and unenhanced scans met all inclusion criteria. In this predominantly inpatient cohort, the incidence of AKI significantly increased with decreasing baseline eGFR (P < .0001). However, this incidence was not significantly different between contrast material and non-contrast material groups in any eGFR subgroup; for the subgroup with eGFR of 90 or greater (n = 1642), odds ratio (OR) was 0.91 (95% confidence interval [CI]: 0.38, 2.15), P = .82; for the subgroup with eGFR of 60-89 (n = 3870), OR was 1.03 (95% CI: 0.66, 1.60), P = .99; for the subgroup with eGFR of 30-59 (n = 5510), OR was 0.94 (95% CI: 0.76, 1.18), P = .65; and for the subgroup with eGFR of less than 30 mL/min/1.73 m2 (n = 1486), OR was 0.97 (95% CI: 0.72, 1.30), P = .89.Diminished eGFR is associated with an increased risk of SCr-defined AKI following CT examinations. However, the risk of AKI is independent of contrast material exposure, even in patients with eGFR of less than 30 mL/min/1.73 m2. (C) RSNA, 2013