碘克沙醇：在接受诊断性计算机断层扫描检查的伴有潜在肾功能不全的癌症患者中发生对比剂肾病的风险

Iodixanol: risk of subsequent contrast nephropathy in cancer patients with underlying renal insufficiency undergoing diagnostic computed tomography examinations.

作者信息

Cheruvu Bharadwaj, Henning Kathleen, Mulligan Janine, Klippenstein Donald, Lawrence David, Gurtoo Lalit, Gottlieb Ronald H

机构信息

Roswell Park Cancer Institute, Buffalo, NY 14263, USA.

出版信息

J Comput Assist Tomogr. 2007 Jul-Aug;31(4):493-8. doi: 10.1097/rct.0b013e31802e29d9.

DOI:10.1097/rct.0b013e31802e29d9

PMID:17882021

Abstract

OBJECTIVE

To assess the risk of contrast-induced nephropathy in cancer patients with underlying renal insufficiency receiving the iso-osmolar intravenous contrast agent iodixanol for diagnostic computed tomography (CT) examinations.

METHODS

Institutional review board approval was obtained with waiver of informed consent. Our study was a retrospective evaluation comparing the incidence of contrast-induced nephropathy in consecutive patients with underlying renal insufficiency undergoing diagnostic CT examinations receiving iodixanol from November 2003 to June 2005 with a comparison group of patients with normal baseline renal function over the same period. Renal insufficiency was considered a serum creatinine level more than 1.2 mg/dL in females and more than 1.5 mg/dL in males. Contrast nephropathy was considered an absolute elevation of 0.5 mg/dL or 25% elevation in serum creatinine level.

RESULTS

In the group of patients receiving iodixanol with underlying renal insufficiency (189 patients), 9.0% developed contrast nephropathy (P = 0.015) with 4.8% of patients developing irreversible renal damage (P = 0.03). This compared with 4.9% of patients receiving iodixanol (185 patients) and 3.1% of patients receiving iohexol (194 patients) with normal baseline renal function developing contrast nephropathy (P = 0.38) with 3.2% of the iodixanol patients and 1.0% of the iohexol patients developing irreversible renal damage (P = 0.13).

CONCLUSIONS

The risk of contrast-induced nephropathy is significantly higher in patients with underlying renal insufficiency receiving iodixanol than that for patients with normal baseline renal function, but this should not serve as an absolute contraindication for these patients to receive intravenous iodinated contrast for diagnostic CT examinations particularly in patients with life-threatening clinical questions in which contrasted CT may provide valuable information.

摘要

目的

评估患有潜在肾功能不全的癌症患者在接受等渗静脉造影剂碘克沙醇进行诊断性计算机断层扫描（CT）检查时发生对比剂肾病的风险。

方法

获得机构审查委员会批准并豁免知情同意。我们的研究是一项回顾性评估，比较了2003年11月至2005年6月期间连续接受碘克沙醇进行诊断性CT检查的潜在肾功能不全患者与同期基线肾功能正常的对照组患者中对比剂肾病的发生率。女性血清肌酐水平超过1.2mg/dL、男性超过1.5mg/dL被视为肾功能不全。对比剂肾病被定义为血清肌酐水平绝对升高0.5mg/dL或升高25%。

结果

在接受碘克沙醇且有潜在肾功能不全的患者组（189例患者）中，9.0%发生了对比剂肾病（P = 0.015），4.8%的患者发生了不可逆性肾损伤（P = 0.03）。相比之下，基线肾功能正常的接受碘克沙醇的患者（185例患者）中有4.9%发生对比剂肾病，接受碘海醇的患者（194例患者）中有3.1%发生对比剂肾病（P = 0.38），碘克沙醇组中3.2%的患者和碘海醇组中1.0%的患者发生了不可逆性肾损伤（P = 0.13）。