Evidence-based Approach for Prevention of Radiocontrast-induced Nephropathy
Evidence-based Approach for Prevention of Radiocontrast-induced Nephropathy
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DOI：
10.1002/jhm.477
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发表时间：
2009-10-01
影响因子：
2.6
通讯作者：
Schelling, Jeffrey R.
中科院分区：
文献类型：
--
作者：
Abu Jawdeh, Bassam G.;Kanso, Abbas A.;Schelling, Jeffrey R.
放射造影剂给药的频率正在急剧增加，每年在全球范围内提供超过8000万剂。尽管最近开发的放射造影剂对大多数患者相对安全，但造影剂肾病(CN)仍然是住院和长期发病率和死亡率的主要来源，特别是在既有肾脏疾病的患者中。已经研究了预防CN的多种方案；然而，尚未建立严格的指南，部分原因是大多数预防方法的疗效数据相互矛盾。在这项工作中，我们严格回顾了涉及常见CN预防策略的主要试验，包括放射造影剂类型、N-乙酰半胱氨酸给药、细胞外液容量扩张和血液滤过/血液透析。我们总结了预防CN的循证建议，强调同时输注NaHCO3和给予N-乙酰半胱氨酸。这些指南应该对经常要求进行放射造影剂检查的住院医生有帮助，因此可能对预防CN产生重大影响。《医院医学杂志》2009；4：500-506。(C)2009年香港医院医学会。
The frequency of radiocontrast administration is dramatically increasing, with over 80 million doses delivered annually worldwide. Although recently developed radiocontrast agents are relatively safe in most patients, contrast nephropathy (CN) is still a major source of in-hospital and long-term morbidity and mortality, particularly in patients with preexisting kidney disease. Multiple protocols for CN prevention have been studied; however, strict guidelines have not been established, in part because of conflicting efficacy data for most prevention approaches. In this work, we critically review the major trials that have addressed common CN prophylaxis strategies, including type of radiocontrast media, N-acetylcysteine administration, extracellular fluid volume expansion, and hemofiltration/hemodialysis. We conclude with evidence-based recommendations for CN prevention, which emphasize concurrent NaHCO3 infusion and N-acetylcysteine administration. These guidelines should be helpful to hospitalists, who frequently order radiocontrast studies, and could therefore have a significant impact on prevention of CN. Journal of Hospital Medicine 2009;4:500-506. (C) 2009 Society of Hospital Medicine.