What are radiologists doing to prevent contrast-induced nephropathy (CIN) compared with measures supported by current evidence? A survey of European radiologists on CIN associated with computed tomography
What are radiologists doing to prevent contrast-induced nephropathy (CIN) compared with measures supported by current evidence? A survey of European radiologists on CIN associated with computed tomography
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DOI：
10.1080/02841850701858257
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发表时间：
2008-01-01
期刊：
影响因子：
1.3
通讯作者：
Reddan, D.
中科院分区：
文献类型：
--
作者：
Fishman, E. K.;Reddan, D.
背景资料：造影剂肾病（CIN）是使用碘化造影剂（CM）的严重并发症，与发病率和死亡率的增加有关。目的：探讨放射科医生是否采取足够的措施，以防止CIN在计算机断层扫描（CT）。材料和方法：2005年调查的509名欧洲放射科医生有3年的经验，并进行了50 CT扫描/周。结果：用于识别CIN风险患者的最常见方法是肾功能测量（64%），临床判断（55%）和患者问卷调查（31%）; 9%没有常规尝试识别风险患者。在高危患者中使用的最常见的预防方案包括：静脉内（i. v.）CT前/后盐水容量补充（59%）或口服水化（52%）;使用低渗CM（LOCM; 40%）或等渗CM（IOCM; 36%）;和N-乙酰半胱氨酸（20%）; 8%未使用水化方案。78%的受访者在高风险患者中使用100 ml CM，14%使用150 ml，9%没有设置体积限制。对于57%的受访者，渗透压摩尔浓度是在风险患者中选择碘化CM的最重要属性; 41%的受访者同意IOCM的CIN风险低于LOCM结论：一项欧洲放射科医师调查发现，需要加强实施循证方案，以改善CIN预防：常规识别高危患者;停用肾毒性药物;使用容量补充方案;尽可能低的CM容量;以及适当的CM。
Background: Contrast-induced nephropathy (CIN) is a serious complication of the use of iodinated contrast media (CM), and is associated with increased morbidity and mortality.Purpose: To investigate whether radiologists take sufficient measures to prevent CIN in computed tomography (CT).Material and Methods: 2005 survey of 509 European radiologists who had 3 years' experience and performed 50 CT scans/week.Results: The most common methods used to identify patients at risk of CIN were renal function measurements (64%), clinical judgment (55%), and patient questionnaires (31%); 9% made no routine attempt to identify at-risk patients. The most common preventive protocols used in at-risk patients included: intravenous (i.v.) saline volume repletion (59%) or oral hydration (52%) before/after CT; use of low-osmolar CM (LOCM; 40%) or isosmolar CM (IOCM; 36%); and N-acetylcysteine (20%); 8% used no hydration regimen. While 78% of respondents used 100 ml of CM in high-risk patients, 14% used 150 ml, and 9% set no volume limit. For 57% of respondents, osmolality was the most important attribute in choosing an iodinated CM in at-risk patients; 41% agreed that CIN risk is lower with IOCM versus LOCM (31% disagreed).Conclusion: A European radiologist survey identified a need for increased implementation of evidence-based protocols to improve CIN prevention: routine identification of at-risk patients; withdrawal of nephrotoxic drugs; use of volume repletion regimens; lowest possible volume of CM; and appropriate CM.