Shinoda Toshio, Hata Toshihiko, Nakajima Ken-ichi, Yoshimoto Hiroshi, Niwa Akihiro
Department of Medicine, Division of Nephrology and Dialysis, Social Insurance Chuo General Hospital, Tokyo, Japan.
Ther Apher. 2002 Dec;6(6):437-42. doi: 10.1046/j.1526-0968.2002.00469.x.
The study was designed to examine the time-course of iodine elimination by hemodialysis to determine a desirable duration for dialysis after angiography to prevent contrast media nephropathy (CMN) in patients with renal failure. Reduction rates of iodine by hemodialysis (DRR) of 1 to 3 h and the renal elimination of iodine (RER) for 20 h after hemodialysis were prospectively examined in 8 chronic renal failure (CRF) patients. The mean DRR was 46.6% at 1 h, 65.2% at 2 h, and 75.1% at 3 h, and the mean RER was 49.4% in the CRF patients. Renal function significantly deteriorated in 2 CRF patients after angiography. Plasma iodine was eliminated by more than 80% after 2 h of hemodialysis following angiography, and the subsequent renal elimination in patients with mild-to-moderate renal failure was also examined. There is no need of prophylactic hemodialysis to prevent CMN for these patients when they have no additional risk factors such as a high dose of contrast medium, diabetes mellitus, or severe heart failure. However, 2 h of hemodialysis is desirable immediately after angiography for patients with moderate renal failure and one additional risk factor, and three hours or more of hemodialysis is also desirable for patients with severe renal failure, and for those with moderate renal failure having two or more additional risk factors.
本研究旨在探讨血液透析清除碘的时间进程，以确定血管造影术后理想的透析时长，从而预防肾衰竭患者发生造影剂肾病（CMN）。对8例慢性肾衰竭（CRF）患者前瞻性地检测了血液透析1至3小时的碘清除率（DRR）以及血液透析后20小时的肾脏碘清除率（RER）。CRF患者1小时时的平均DRR为46.6%，2小时时为65.2%，3小时时为75.1%，平均RER为49.4%。2例CRF患者在血管造影术后肾功能显著恶化。血管造影术后进行2小时血液透析后，血浆碘清除率超过80%，同时还检测了轻至中度肾衰竭患者随后的肾脏清除情况。对于这些没有高剂量造影剂、糖尿病或严重心力衰竭等额外危险因素的患者，无需进行预防性血液透析来预防CMN。然而，对于中度肾衰竭且有一个额外危险因素的患者，血管造影术后立即进行2小时血液透析是可取的；对于重度肾衰竭患者，以及中度肾衰竭且有两个或更多额外危险因素的患者，进行三小时或更长时间的血液透析也是可取的。
