Dittrich Elisabeth, Puttinger Heidi, Schillinger Martin, Lang Irene, Stefenelli Thomas, Hörl Walter H, Vychytil Andreas
Division of Nephrology and Dialysis, Department of Medicine III, Medical University Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria.
Nephrol Dial Transplant. 2006 May;21(5):1334-9. doi: 10.1093/ndt/gfi023. Epub 2005 Jul 26.
Residual renal function is an independent predictor of survival in peritoneal dialysis patients. Systemic administration of radio contrast media (CM) may increase the risk of acute renal failure in patients with impaired renal function not on dialysis. There are few data on the influence of CM administration in dialysis patients.
We investigated residual renal function in 10 continuous ambulatory peritoneal dialysis (CAPD) patients who underwent elective diagnostic intravenous or intra-arterial administration of CM (study group). Iopromide (a iodinated, non-ionic hypo-osmolar CM) was used for all interventions. The median dose of CM given was 107.5 ml/patient. Residual renal function (calculated as the average of renal creatinine and renal urea clearance) was measured on the day before the intervention (baseline), on days 1-7, day 10 and day 30 after intervention. Eight CAPD patients without exposure to CM acted as the control group.
There was no significant difference between the two groups in age, gender, diabetes, duration of dialysis and renal clearance at baseline. In the study group, we observed a temporary decline of residual renal clearance after administration of CM (P<0.05; Friedman test). On day 30, clearances were not significantly different from baseline. In the control group, there was no significant change of residual clearance during the observation period. Repeated measures ANOVA revealed no significant difference in the course of residual renal function between study and control groups. The decline of residual renal clearance between baseline and a routine visit after 4 months was comparable between groups.
Administration of iopromide did not lead to a persistent decline of residual renal function in CAPD patients. Nevertheless, non-ionic hypo-osmolar CM should be given to these patients with the lowest possible dose and only if there is a real clinical indication.
残余肾功能是腹膜透析患者生存的独立预测因素。对于未接受透析但肾功能受损的患者，全身使用放射性造影剂（CM）可能会增加急性肾衰竭的风险。关于CM给药对透析患者的影响的数据很少。
我们调查了10例接受择期诊断性静脉或动脉内CM给药的持续性非卧床腹膜透析（CAPD）患者的残余肾功能（研究组）。所有干预均使用碘普罗胺（一种碘化非离子低渗CM）。CM的中位给药剂量为107.5 ml/患者。在干预前一天（基线）、干预后第1 - 7天、第10天和第30天测量残余肾功能（计算为肾肌酐清除率和肾尿素清除率的平均值）。8例未接触CM的CAPD患者作为对照组。
两组在年龄、性别、糖尿病、透析时间和基线时的肾清除率方面无显著差异。在研究组中，我们观察到CM给药后残余肾清除率暂时下降（P<0.05；Friedman检验）。在第30天，清除率与基线无显著差异。在对照组中，观察期内残余清除率无显著变化。重复测量方差分析显示，研究组和对照组之间残余肾功能的变化过程无显著差异。两组在基线至4个月后的常规随访期间残余肾清除率的下降情况相当。
碘普罗胺给药并未导致CAPD患者残余肾功能持续下降。然而，应仅在有实际临床指征时，以尽可能低的剂量给这些患者使用非离子低渗CM。
