IV contrast administration for CT: A survey of practices for the screening and prevention of contrast nephropathy
IV contrast administration for CT: A survey of practices for the screening and prevention of contrast nephropathy
复制标题
DOI：
10.2214/ajr.05.0407
复制
发表时间：
2006-06-01
影响因子：
5
通讯作者：
Weinreb, JC
中科院分区：
文献类型：
--
作者：
Elicker, BM;Cypel, YS;Weinreb, JC
OBJECTIVE.对于接受碘化IV造影剂进行CT检查的患者，目前尚无广泛接受的造影剂肾病筛查和预防实践指南。问题包括筛查以识别风险患者，肾功能不全的歧视性水平，超过该水平静脉造影剂是禁忌的，以及预防措施的使用。我们对放射科医生进行了调查，以确定当前的实践模式，并确定最需要指南的领域。材料和方法。调查通过电子邮件发送给了2,000名放射科医生。调查包括关于上述问题的问题和受访者的人口统计数据。回答率为21%。血清肌酐是最常用的筛查方法：92%的受访者用于住院检查，66%用于门诊检查。只有2%的人使用估计的肌酐清除率。用于确定患者不应接受IV造影剂的平均阈值血清肌酐值为1.5 mg/dL（35%）、1.7 mg/dL（27%）和2.0 mg/dL（31%）（平均值为1.78 mg/dL）。糖尿病轻微降低肌酐阈值（平均值为1.68 mg/dL）。不到30%的受访者经常对肾移植或多发性骨髓瘤患者静脉注射造影剂。最常用的预防措施包括水化（93%）、减少造影剂剂量（77%）和给予乙酰半胱氨酸（39%）。总体而言，没有发现重要的差异之间的做法设置或专业化水平。在造影剂肾病的筛查和预防方面，实践模式的差异很大。在某些情况下，这些模式与文献中的建议相冲突。本研究的结果确定了进一步研究的机会和需要改进实践指南的领域。
OBJECTIVE. No widely accepted practice guidelines exist for the screening and prevention of contrast nephropathy in patients receiving iodinated IV contrast agents for CT examinations. Issues include screening to identify at-risk patients, discriminatory levels of renal insufficiency beyond which IV contrast material is contraindicated, and the use of preventive measures. We surveyed radiologists to identify the current practice patterns and to determine those areas in which guidelines are most needed.MATERIALS AND METHODS. Surveys were e-mailed to 2,000 radiologists. The survey included questions on the issues just described and respondent demographics.RESULTS. The response rate was 21%. Serum creatinine is the most commonly used screening method: 92% of respondents for inpatient examinations and 66% for outpatient examinations. Only 2% use estimated creatinine clearance. The average threshold serum creatinine value used to determine that patients should not receive IV contrast material is 1.5 mg/dL in 35%,1.7 mg/dL in 27%, and 2.0 mg/dL in 31% (mean, 1.78 mg/dL). Diabetes slightly lowers the threshold creatinine (mean, 1.68 mg/dL). Fewer than 30% of respondents frequently administer IV contrast material to patients with a renal transplant or multiple myeloma. The most commonly used preventive measures include hydration (93%), reduction of contrast dose (77%), and administration of acetylcysteine (39%). Overall, no important differences were found among practice settings or level of specialization.CONCLUSION. A wide variation of practice patterns is apparent in the screening and prevention of contrast nephropathy. In some cases, these patterns conflict with recommendations from the literature. The results of this study identify opportunities for further research and areas in need of improved practice guidelines.