Contrast Material-induced Nephrotoxicity and Intravenous Low-Osmolality Iodinated Contrast Material
Contrast Material-induced Nephrotoxicity and Intravenous Low-Osmolality Iodinated Contrast Material
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DOI：
10.1148/radiol.12121394
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发表时间：
2013-04-01
期刊：
影响因子：
19.7
通讯作者：
Ellis, James H.
中科院分区：
文献类型：
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作者：
Davenport, Matthew S.;Khalatbari, Shokoufeh;Ellis, James H.
目的：探讨静脉注射低渗碘造影剂是否与CT后急性肾损伤（AKI）有关。材料和方法：这项符合hipaa的回顾性研究获得了机构审查委员会的批准，并放弃了患者的同意。在10年的时间里，对血清肌酐（SCr）数据充足的成年住院患者进行了CT检查。以CT后AKI为主要结局指标（20242例患者中10121例未增强和10121例静脉对比增强CT检查），进行一对一倾向匹配匹配队列分析，并进行多变量效应分析。对患者接受静脉造影剂的可能性进行倾向匹配（36个检验协变量）。根据急性肾损伤网络SCr标准，主要终点为ct后AKI；次要终点为ct后AKI，采用传统的SCr标准判断造影剂引起的肾毒性（CIN； SCr升高>= 0.5 mg/dL [44.20 mu mol/L]或>= 25%）。进行多变量亚组阈值分析（SCr = 2.0 mg/dL[>= 132.60至>= 176.80 mu mol/L]），并根据分配的倾向评分进行调整。结果：对于ct前SCr水平为1.6 mg/dL （141.44 mu mol/L）或更高的患者，静脉注射低渗碘造影剂对ct后AKI的发展有显著影响（优势比为1.45；95%可信区间[CI]: 1.11, 1.89; P = 0.007）。这种效果随着ct前SCr的增加而增强。稳定SCr低于1.5 mg/dL （132.60 mu mol/L）的患者没有发生CIN的风险（P = 0.25，功率）。95%)。两个终点显示相似的结果（例如，使用传统CIN标准，SCr >= 1.6 mg/dL [141.44 mu mol/L]：优势比为1.64;95% CI: 1.18, 2.28; P = 0.003）。CT后AKI在未增强和增强CT亚组中都很普遍，并且随着CT前SCr的增加而增加。许多危险因素导致了ct后AKI的发展，与碘化造影剂无关。结论：静脉注射低渗碘造影剂是一个肾毒性危险因素，但在SCr稳定水平低于1.5 mg/dL的患者中不存在。除造影剂外，还有许多因素可影响ct后AKI发生率。(c) RSNA， 2013年
Purpose: To determine whether intravenous low-osmolality iodinated contrast material is associated with post-computed tomography (CT) acute kidney injury (AKI).Materials and Methods: Institutional review board approval was obtained and patient consent waived for this HIPAA-compliant retrospective study. CT examinations performed over a 10-year period in adult inpatients with sufficient serum creatinine (SCr) data were identified. A one-to-one propensity-matched matched cohort analysis with multivariate analysis of effects was performed with post-CT AKI as the primary outcome measure (10 121 unenhanced and 10 121 intravenous contrast-enhanced CT examinations in 20 242 patients). Propensity matching was performed with respect to likelihood of patient receiving intravenous contrast material (36 tested covariates). The primary endpoint was post-CT AKI by using Acute Kidney Injury Network SCr criteria; the secondary endpoint was post-CT AKI by using traditional SCr criteria for contrast material-induced nephrotoxicity (CIN; SCr increase >= 0.5 mg/dL [44.20 mu mol/L] or >= 25%). Multivariate subgroup threshold analysis was performed (SCr = 2.0 mg/dL [>= 132.60 to >= 176.80 mu mol/L]) and adjusted for assigned propensity scores.Results: Intravenous low-osmolality iodinated contrast material had a significant effect on the development of post-CT AKI for patients with pre-CT SCr levels of 1.6 mg/dL (141.44 mu mol/L) or greater (odds ratio, 1.45; 95% confidence interval [CI]: 1.11, 1.89; P = .007). This effect strengthened as pre-CT SCr increased. Patients with stable SCr less than 1.5 mg/dL (132.60 mu mol/L) were not at risk for developing CIN (P = .25, power. 95%). Both end-points demonstrated similar results (eg, SCr >= 1.6 mg/dL [141.44 mu mol/L] by using traditional CIN criteria: odds ratio, 1.64; 95% CI: 1.18, 2.28; P = .003). Post-CT AKI was prevalent in both the unenhanced and contrast-enhanced CT subgroups, and it increased with increases in pre-CT SCr. Many risk factors contributed to development of post-CT AKI, regardless of iodinated contrast material.Conclusion: Intravenous low-osmolality iodinated contrast material is a nephrotoxic risk factor, but not in patients with a stable SCr level less than 1.5 mg/dL. Many factors other than contrast material can affect post-CT AKI rates. (c) RSNA, 2013