Nephrotoxic effects in high-risk patients undergoing angiography.
Nephrotoxic effects in high-risk patients undergoing angiography.
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DOI：
10.1056/nejmoa021833
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发表时间：
2003-02-06
影响因子：
158.5
通讯作者：
Berg, KJ
中科院分区：
文献类型：
--
作者：
Aspelin, P;Aubry, P;Berg, KJ
背景：使用含碘造影剂可导致肾病。在高危患者中，等渗造影剂是否比低渗造影剂的肾毒性更小尚不确定。方法：我们进行了一项随机、双盲、前瞻性、多中心研究，比较了异渗透压、二聚体、非离子造影剂碘二醇与低渗透压、非离子、单体造影剂碘己醇的肾毒性作用。该研究纳入了129例糖尿病患者，他们的血清肌酐浓度为每分升1.5至3.5毫克，并接受了冠状动脉或主动脉血管造影。主要终点是血管造影后3天内肌酐浓度从基线上升的峰值。其他终点是肌酐浓度增加0.5 mg /分升或更高，增加1.0 mg /分升或更高，以及从第0天到第7天肌酐浓度的变化。结果：服用碘沙醇组肌酐浓度升高明显减少。从第0天到第3天，碘二沙醇组肌酐的平均峰值增加为0.13 mg /分升，碘己醇组为0.55 mg /分升（P=0.001；碘二沙醇组的增加减去碘己醇组的增加，为-0.42 mg /分升[95%置信区间，-0.73至-0.22]）。碘沙醇组64例患者中有2例（3%）肌酐浓度升高0.5 mg /分升以上，而碘沙醇组65例患者中有17例（26%）肌酐浓度升高（P=0.002；碘沙醇组肌酐浓度升高的优势比为0.09[95%可信区间，0.02 ~ 0.41]）。没有接受碘沙醇治疗的患者每分升血压升高1.0毫克或更高，但碘己醇组有10名患者（15%）血压升高。从第0天到第7天，碘二沙醇组肌酐浓度的平均变化为0.07 mg /分升，碘己醇组为0.24 mg /分升（P=0.003；碘二沙醇组值减去碘己醇组值，-0.17 mg /分升[95%置信区间，-0.34至-0.07]）。结论：在高危患者中，使用碘沙醇而不是低渗透压、非离子造影剂时，造影剂引起的肾病可能不太可能发生。
Background:The use of iodinated contrast medium can result in nephropathy. Whether iso-osmolar contrast medium is less nephrotoxic than low-osmolar contrast medium in high-risk patients is uncertain.Methods:We conducted a randomized, double-blind, prospective, multicenter study comparing the nephrotoxic effects of an iso-osmolar, dimeric, nonionic contrast medium, iodixanol, with those of a low-osmolar, nonionic, monomeric contrast medium, iohexol. The study involved 129 patients with diabetes with serum creatinine concentrations of 1.5 to 3.5 mg per deciliter who underwent coronary or aortofemoral angiography. The primary end point was the peak increase from base line in the creatinine concentration during the three days after angiography. Other end points were an increase in the creatinine concentration of 0.5 mg per deciliter or more, an increase of 1.0 mg per deciliter or more, and a change in the creatinine concentration from day 0 to day 7.Results:The creatinine concentration increased significantly less in patients who received iodixanol. From day 0 to day 3, the mean peak increase in creatinine was 0.13 mg per deciliter in the iodixanol group and 0.55 mg per deciliter in the iohexol group (P=0.001; the increase with iodixanol minus the increase with iohexol, -0.42 mg per deciliter [95 percent confidence interval, -0.73 to -0.22]). Two of the 64 patients in the iodixanol group (3 percent) had an increase in the creatinine concentration of 0.5 mg per deciliter or more, as compared with 17 of the 65 patients in the iohexol group (26 percent) (P=0.002; odds ratio for such an increase in the iodixanol group, 0.09 [95 percent confidence interval, 0.02 to 0.41]). No patient receiving iodixanol had an increase of 1.0 mg per deciliter or more, but 10 patients in the iohexol group (15 percent) did. The mean change in the creatinine concentration from day 0 to day 7 was 0.07 mg per deciliter in the iodixanol group and 0.24 mg per deciliter in the iohexol group (P=0.003; value in the iodixanol group minus the value in the iohexol group, -0.17 mg per deciliter [95 percent confidence interval, -0.34 to -0.07]).Conclusions:Nephropathy induced by contrast medium may be less likely to develop in high-risk patients when iodixanol is used rather than a low-osmolar, nonionic contrast medium.