Background Fluctuation of Kidney Function Versus Contrast-Induced Nephrotoxicity
Background Fluctuation of Kidney Function Versus Contrast-Induced Nephrotoxicity
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DOI：
10.2214/ajr.08.1413
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发表时间：
2009-03-01
影响因子：
5
通讯作者：
Pozniak, Myron A.
中科院分区：
文献类型：
--
作者：
Bruce, Richard J.;Djamali, Aji;Pozniak, Myron A.
客观的。所报道的对比剂引起的急性肾损伤的发生率差异很大。几乎没有研究量化接受碘造影剂的患者肾功能的背景波动。本研究的目的是回顾性比较接受低渗透（碘海醇）或等渗（碘克沙醇）造影剂的 CT 患者与未使用造影剂接受 CT 的患者的急性肾损伤发生率。 材料和方法。对 11,588 名患者的肌酐浓度和估计肾小球滤过率进行了评估。比较各组的急性肾损伤发生率（定义为CT后3天内血清肌酐浓度增加0.5 mg/dL或估计肾小球滤过率下降25%或以上），并根据影像学检查前肌酐浓度和估计肾小球滤过率进行分层。 结果。在所有组中，急性肾损伤的发生率随着基线肌酐浓度的增加而增加。等渗造影剂组和对照组之间推定的造影剂肾损伤的发生率没有显着差异。低渗透造影剂组的急性肾损伤发生率与肌酐水平达到 1.8 mg/dL 的对照组相似，但肌酐水平高于此水平与急性肾损伤发生率较高相关。 结论。我们发现接受平扫 CT 的对照受试者中急性肾损伤的发生率很高。对于所有基线肌酐值和慢性肾病的所有阶段，该组中肌酐升高的发生率在统计学上与等渗造影剂组相似。这些发现表明，伴随使用造影剂（造影剂引起的肾毒性）而产生的急性肾损伤的额外风险可能被夸大了，并且这些患者的肌酐升高大部分可归因于背景波动、基础疾病或治疗。
OBJECTIVE. The reported incidence of contrast-induced acute kidney injury varies widely. Almost no studies have been conducted to quantify the background fluctuation of kidney function of patients receiving iodinated contrast medium. The purpose of this study was a retrospective comparison of the incidence of acute kidney injury among patients undergoing CT with low-osmolar (iohexol) or isoosmolar (iodixanol) contrast medium with the incidence among patients undergoing CT without contrast administration.MATERIALS and METHODS. Creatinine concentration and estimated glomerular filtration rate were evaluated for 11,588 patients. Rates of acute kidney injury (defined as a 0.5 mg/dL increase in serum creatinine concentration or a 25% or greater decrease in estimated glomerular filtration rate within 3 days after CT) were compared among groups and stratified according to creatinine concentration and estimated glomerular filtration rate before the imaging examination.RESULTS. In all groups, the incidence of acute kidney injury increased with increasing baseline creatinine concentration. No significant difference in incidence of presumed contrast-induced kidney injury was identified between the isoosmolar contrast medium and the control groups. The incidence of acute kidney injury in the low-osmolar contrast medium cohort paralleled that of the control cohort up to a creatinine level of 1.8 mg/dL, but increases above this level were associated with a higher incidence of acute kidney injury.CONCLUSION. We identified a high incidence of acute kidney injury among control subjects undergoing unenhanced CT. The incidence of creatinine elevation in this group was statistically similar to that in the isoosmolar contrast medium group for all baseline creatinine values and all stages of chronic kidney disease. These findings suggest that the additional risk of acute kidney injury accompanying administration of contrast medium (contrast-induced nephrotoxicity) may be overstated and that much of the creatinine elevation in these patients is attributable to background fluctuation, underlying disease, or treatment.