Iso-osmolality versus low-osmolality iodinated contrast medium at intravenous contrast-enhanced CT: Effect on kidney function
Iso-osmolality versus low-osmolality iodinated contrast medium at intravenous contrast-enhanced CT: Effect on kidney function
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DOI：
10.1148/radiol.2481071484
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发表时间：
2008-07-01
期刊：
影响因子：
19.7
通讯作者：
Schoepf, U. Joseph
中科院分区：
文献类型：
--
作者：
Nguyen, Shaun A.;Suranyi, Pal;Schoepf, U. Joseph
目的：比较等渗造影剂和低渗造影剂对接受静脉注射造影剂增强CT的高危患者肾功能(血肌酐[Scr]和肾小球滤过率[GFR])的影响。材料和方法：这项符合HIPAA标准的研究是IRB批准的，并征得正式同意。117例肾功能减退的患者(男性83例，女性34例；平均年龄64.3岁；年龄18-86岁)接受了等渗碘二醇(n=61)或低渗碘普罗胺(n=56)的增强CT扫描。观察指标为CT后3天内Scr升高或GFR降低，Scr升高(Of-gt；=0.5 mg/dL[44.2Mol/L，25%]或>；=1.0 mg/dL[88.4MU/L，50%])，GFR降低(OF；结果：IOXANO使Scr从基线时的1.77 mg/dL+/-0.24(156.47 mU/L+/-21.22)降至第1天的1.65 mg/dL+/-0.35(145.86 mU/L+/-30.94，P=0.046)、1.73 mg/dL+/-0.53(152.93 mU/L+/-46.85)，第1天为1.73 mg/dL+/-0.55(152.93 mU/dL+/-48.62，不显著)，第3天为1.73 mg/dL+/-0.55(不显著)。碘普罗胺使Scr从基线的1.75 mg/dL+/-0.32(154.7 mU/L+/-28.29)增加到1.8 mg/dL+/-0.42(159.12 mU/L+/-15.59)，2天的1.77 mg/dL+/-0.49(156.47 mU/L+/-43.32)，和3天的1.77 mg/dL+/-0.62(156.47 mU/L+/-54.81)(无统计学意义)。CT后3天，碘化醇升高，碘普罗胺降低肾小球滤过率(P<0.05)。肌酐升高-gt；=0.5 mg/dL或更高(=25%，P=.012)的患者，碘地黄醇组(8.5%)少于碘普罗胺组(27.8%)。两组各有2例Scr升高1.0 mg/dL或以上(无统计学意义)。碘普罗胺组患者(42.3%)的GFR下降幅度大于或高于碘羟醇组(24.1%)(P=0.0426)。在30天或90天的随访中，没有患者发生与造影剂相关的不良事件。结论：在高危患者中静脉应用造影剂不太可能与永久性不良结果相关。注射造影剂后，碘代沙诺组的Scr水平低于碘普罗胺组。(C)RSNA，2008年。
Purpose: To determine the effects of iso-osmolality contrast medium compared with a low-osmolality agent on renal function (serum creatinine [SCr] and glomerular filtration rate [GFR]) in high-risk patients undergoing intravenous contrast material-enhanced CT.Materials and Methods: This HIPAA-compliant study was IRB-approved; formal consent was obtained. One hundred seventeen patients (83 men, 34 women; mean age, 64.3 years; range, 18-86 years) with decreased renal function underwent contrast-enhanced CT with either iso-osmolality iodixanol (n = 61) or low-osmolality iopromide (n = 56). Outcome measures were of SCr increase or GFR decrease for 3 days after CT, a SCr increase (of >= 0.5 mg/dL [44.2 mu mol/L, 25%] or >= 1.0 mg/dL [88.4 mu mol/L, 50%]), a GFR reduction (of >= 5 mL/min), and patient outcome at 30- and 90-day follow-up.Results: Iodixanol decreased SCr (mean +/- standard deviation) from 1.77 mg/dL +/- 0.24 (156.47 mu mol/L +/- 21.22) at baseline to 1.65 mg/dL +/- 0.35 (145.86 mu mol/L +/- 30.94, P = .046) at day 1, 1.73 mg/dL +/- 0.53 (152.93 mu mol/L +/- 46.85, not significant) at day 2, and 1.73 mg/dL +/- 0.55 (152.93 mu mol/L +/- 48.62, not significant) at day 3 ( not significant). Iopromide increased SCr from 1.75 mg/dL +/- 0.32 (154.7 mu mol/L +/- 28.29) at baseline to 1.8 mg/dL +/- 0.42 (159.12 mu mol/L +/- 15.59) at day 1, 1.77 mg/dL +/- 0.49 (156.47 mu mol/L +/- 43.32) at day 2, and 1.77 mg/dL +/- 0.62 (156.47 mu mol/L +/- 54.81) at day 3 (not significant). Iodixanol increased and iopromide decreased GFR on all 3 days after CT (not significant). Fewer patients in the iodixanol group (8.5%) than in the iopromide group (27.8%) had SCr increase >= 0.5 mg/dL or higher (>= 25%, P = .012). Two patients in each group had SCr increase of 1.0 mg/dL or more ( not significant). More patients in the iopromide group (42.3%) than in the iodoxanol group (24.1%) had a GFR reduction of 5 mL/min or higher (P=.0426). No patient had a contrast material-related adverse event at 30- or 90-day follow-up.Conclusion: Intravenous contrast material application in high-risk patients is unlikely to be associated with permanent adverse outcomes. SCr levels after contrast material administration are lower in iodixanol than iopromide groups. (c) RSNA, 2008.