Rudnick Michael, Feldman Harold
Renal Electrolyte and Hypertension Division, Penn Presbyterian Medical Center, Philadelphia, Pennsylvania 19104, USA.
Clin J Am Soc Nephrol. 2008 Jan;3(1):263-72. doi: 10.2215/CJN.03690907.
Observational studies have demonstrated that short- and long-term mortality is increased in patients who develop contrast-induced nephropathy (CIN). The more clinically relevant questions, and the objectives of this review, are whether CIN is causally related to mortality, and to what extent could mortality in patients undergoing contrast procedures be reduced by preventing CIN.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: A literature review was conducted, focusing on observational studies that assessed factors associated with mortality in patients with CIN.
The deaths of some patients with CIN are complicated by factors that cannot be directly related to CIN, such as liver disease, sepsis, respiratory failure, bleeding, etc. However, it is plausible that CIN contributes to cardiovascular causes of death in patients with CIN.
At the very least, CIN is a marker for increased mortality. More carefully designed prospective studies are needed to fully elucidate the relationship between CIN and death. In the absence of data disproving a causal relationship between CIN and death in all subgroups, reducing its incidence should remain a goal in clinical practice as well as a target for future research.
观察性研究表明，发生对比剂肾病（CIN）的患者短期和长期死亡率均会升高。本综述更具临床相关性的问题及目的在于，CIN是否与死亡率存在因果关系，以及通过预防CIN能在多大程度上降低接受造影检查患者的死亡率。
设计、研究地点、参与者及测量方法：进行了一项文献综述，重点关注评估CIN患者死亡率相关因素的观察性研究。
一些CIN患者的死亡因无法直接与CIN相关的因素而复杂化，如肝病、败血症、呼吸衰竭、出血等。然而，CIN导致CIN患者心血管死亡原因似乎是合理的。
至少，CIN是死亡率升高的一个标志。需要更精心设计的前瞻性研究来充分阐明CIN与死亡之间的关系。在缺乏反驳所有亚组中CIN与死亡之间因果关系的数据的情况下，降低其发生率应仍是临床实践的目标以及未来研究的靶点。
