碘化造影剂对腹膜透析患者残余肾功能的影响。

Effect of iodinated contrast agents on residual renal function in PD patients.

作者信息

Moranne Olivier, Willoteaux Serge, Pagniez Dominique, Dequiedt Philippe, Boulanger Eric

机构信息

Nephrology Department, University Hospital of Lille II, France.

出版信息

Nephrol Dial Transplant. 2006 Apr;21(4):1040-5. doi: 10.1093/ndt/gfi327. Epub 2005 Dec 13.

DOI:10.1093/ndt/gfi327

PMID:16352623

Abstract

BACKGROUND

Residual renal function (RRF) is an important predictor of outcome in peritoneal dialysis (PD) patients. Although increasing emphasis has been placed on preserving RRF, the nephrotoxicity associated with contrast medium administration in PD patients remains a controversial issue. In the present prospective study, we evaluated the evolution of RRF 2 weeks after iodinated contrast medium administration (ICMA) in a group of stable PD patients, and compared it with that in a non-treated control group of stable PD subjects.

METHODS

The study was conducted from January 2003 to October 2004. RRF was quantified by the average of 24 h urinary urea and creatinine clearance and peritoneal creatinine clearance (PcrCl) were analyzed, the levels of which were analysed prior to and 2 weeks following ICMA in 36 PD patients and also assessed at the same time points in a group of 36 PD non-ICMA control subjects, matched according to RRF characteristics. Two weeks following ICMA, the values for RRF, daily urine volume and PcrCl were assessed against those at baseline, and the evolution of RRF was compared between the two groups. In the ICMA group, this study was performed with adequate pre-hydration and a minimum dose of contrast medium.

RESULTS

Compared with baseline values, RRF, daily urine volume and PcrCl were not found to be significantly different 2 weeks after ICMA (7.0+/-4.3 vs 7.2+/-4.3 ml/min/1.73 m(2), P = 0.12; 1324+/-696 vs 1360+/-755 ml/day, P = 0.5; and 41.1+/-9 vs 40.6+/-9 l/week/1.73 m(2), P = 0.6, respectively). Following ICMA, variations in RRF and daily urine volume were found to be comparable with those of the control group (0.1+/-0.5 vs 0.1+/-0.5 ml/min/1.73 m(2), P = 0.9; 36+/-440 vs 40+/-493 ml/day, P = 0.8, respectively).

CONCLUSION

In this study, 2 weeks following ICMA, no accelerated decline in RRF was determined in stable PD patients with adequate pre-hydration, i.e. subjects treated under optimal circumstances compared with the control group.

摘要

背景

残余肾功能（RRF）是腹膜透析（PD）患者预后的重要预测指标。尽管人们越来越重视保护RRF，但PD患者使用造影剂相关的肾毒性仍是一个有争议的问题。在本前瞻性研究中，我们评估了一组稳定的PD患者在给予碘化造影剂（ICMA）2周后RRF的变化情况，并将其与未接受治疗的稳定PD受试者对照组进行比较。

方法

研究于2003年1月至2004年10月进行。通过24小时尿尿素和肌酐清除率的平均值对RRF进行量化，并分析腹膜肌酐清除率（PcrCl），在36例PD患者ICMA前及ICMA后2周分析其水平，同时在一组36例PD非ICMA对照受试者中在相同时间点进行评估，这些对照受试者根据RRF特征进行匹配。ICMA后2周，将RRF、每日尿量和PcrCl的值与基线值进行比较，并比较两组RRF的变化情况。在ICMA组中，本研究在充分预水化和使用最小剂量造影剂的情况下进行。

结果

与基线值相比，ICMA后2周RRF、每日尿量和PcrCl无显著差异（分别为7.0±4.3 vs 7.2±4.3 ml/min/1.73 m²，P = 0.12；1324±696 vs 1360±755 ml/天，P = 0.5；41.1±9 vs 40.6±9 l/周/1.73 m²，P = 0.6）。ICMA后，发现RRF和每日尿量的变化与对照组相当（分别为0.1±0.5 vs 0.1±0.5 ml/min/1.73 m²，P = 0.9；36±440 vs 40±493 ml/天，P = 0.8）。