Frequency of serum creatinine changes in the absence of iodinated contrast material: Implications for studies of contrast nephrotoxicity
Frequency of serum creatinine changes in the absence of iodinated contrast material: Implications for studies of contrast nephrotoxicity
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DOI：
10.2214/ajr.07.3280
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发表时间：
2008-08-01
影响因子：
5
通讯作者：
Starren, Justin
中科院分区：
文献类型：
--
作者：
Newhouse, Jeffrey H.;Kho, David;Starren, Justin
OBJECTIVE.大多数造影剂肾病的研究缺乏对照，无法将其与其他原因引起的肾病区分开来。我们评估了未接受碘化造影剂的患者血清肌酐变化的频率和幅度，并与有关造影剂肾病的文献中肌酐变化进行比较。从学术医疗中心的电子病历中，确定了连续5天进行肌酐测定且在前10天内未接受造影剂的成人。将第一次肌酐水平与随后几天的肌酐水平进行比较。我们计算了这些水平超过阈值的频率，这些阈值在以前的出版物中用于识别造影剂肾病。在32，161名患者中，超过一半的患者表现出至少25%的变化，超过五分之二，至少0.4 mg/dL的变化。在基线肌酐水平为0.6-1.2 mg/dL的患者中，分别有27%、19%和11%的患者升高至少25%、33%和50%。13%、7%和3%的患者发生0.4、0.6和1.0 mg/dL的升高。在基线肌酐水平大于2.0 mg/dL的患者中，分别有16%、12%和7%的患者升高至少25%、33%和50%。升高0.4、0.6和1.0 mg/ dL的发生率分别为33%、26%和18%。这些增加与先前证实的造影剂肾病的发生率没有差异。未接受造影剂的患者肌酐水平升高的频率与已发表的接受造影剂的患者系列相同。造影剂在肾病中的作用可能被高估。
OBJECTIVE. Most studies of contrast-induced nephropathy lack controls to distinguish it from nephropathy from other causes. We assessed the frequency and magnitude of serum creatinine changes in patients not receiving iodinated contrast material to compare with creatinine changes in publications regarding contrast nephropathy.MATERIALS AND METHODS. From the electronic medical records of an academic medical center, adults with creatinine determinations on five consecutive days who had not received contrast material during the previous 10 days were identified. The first creatinine level was compared with those on subsequent days. We calculated the frequency with which these levels exceeded thresholds used to identify contrast nephropathy in previous publications.RESULTS. Among 32,161 patients, more than half showed a change of at least 25% and more than two fifths, a change of at least 0.4 mg/dL. Among patients with baseline creatinine levels of 0.6-1.2 mg/dL, increases of at least 25%, 33%, and 50% occurred in 27%, 19%, and 11% of patients, respectively. Increases of 0.4, 0.6, and 1.0 mg/dL occurred in 13%, 7%, and 3% of patients. Among patients with baseline creatinine levels greater than 2.0 mg/dL, increases of at least 25%, 33%, and 50% occurred in 16%, 12%, and 7%. Increases of 0.4, 0.6, and 1.0 mg/ dL occurred in 33%, 26%, and 18%. These increases were not different from the incidences of contrast nephropathy previously published.CONCLUSION. The creatinine level increases in patients who are not receiving contrast material as often as it does in published series of patients who are receiving contrast material. The role of contrast material in nephropathy may have been overestimated.