血管紧张素转换酶抑制剂或 AT1 受体阻滞剂对肾素-血管紧张素-醛固酮阻断作用对造影剂诱导肾病发生率的影响：来自透析与利尿剂（DVD）试验的事后分析。

Impact of renin-angiotensin-aldosterone blockade by angiotensin-converting enzyme inhibitors or AT-1 blockers on frequency of contrast medium-induced nephropathy: a post-hoc analysis from the Dialysis-versus-Diuresis (DVD) trial.

机构信息

Department of Pediatric Cardiology, University Hospital of Muenster, Muenster, Germany.

出版信息

Nephrol Dial Transplant. 2010 Mar;25(3):759-64. doi: 10.1093/ndt/gfp582. Epub 2009 Nov 9.

DOI:10.1093/ndt/gfp582

PMID:19903660

Abstract

BACKGROUND

After exposure to contrast medium (CM), about 10% of patients will develop contrast medium-induced nephropathy (CIN), with severe consequences for their prognosis. Although numerous studies evaluated risk factors for CIN development, it is still a matter of debate whether treatment with angiotensin-converting enzyme inhibitors (ACE-I) or AT-1 blockers increases the frequency of CIN after exposure to CM or not.

METHODS

We performed a prospective, single-centre study (January 2001-July 2004) to compare different treatments for CIN prevention. Creatinine levels within 72 h after CM application and in-hospital outcomes were documented. The impact of RAAS blockade on the frequency of CIN was assessed retrospectively.

RESULTS

Four hundred twelve patients were included (83.5% men, 29.1% diabetes mellitus, 74.6% hypertension). Of these, 269 patients (65.3%) were taking ACE-I (n = 236) or AT-1 blockers (n = 33). There were no significant differences in mean age (P = 0.075), creatinine levels (P = 0.113), gender (P = 0.281), diabetes mellitus (P = 0.172) or left ventricular ejection fraction (P = 0.09) between patients treated or not treated with RAAS blockade. Univariate analyses concerning development of CIN depending on treatment with RAAS blockade within 72 h found CIN to be significantly higher in patients treated with RAAS blockade (11.9 vs 4.2%, P = 0.006). Multivariate analyses (logistic regression) identified RAAS blockade to be an independent predictor of CIN (odds ratio 3.082, 95% confidence interval 1.234-7.698, P = 0.016).

CONCLUSION

Patients treated with RAAS blockade before exposure to CM develop significantly more often CIN within 72 h. Even after adjustment for confounding comorbidities, treatment with ACE-I or AT-1 blockers turned out to be an independent risk predictor.

摘要

背景

接触造影剂（CM）后，约 10%的患者会发生造影剂诱导的肾病（CIN），对其预后产生严重后果。尽管许多研究评估了 CIN 发展的危险因素，但 ACEI 或 AT-1 阻滞剂治疗是否会增加 CM 暴露后 CIN 的频率仍存在争议。

方法

我们进行了一项前瞻性、单中心研究（2001 年 1 月至 2004 年 7 月），比较了不同的 CIN 预防治疗方法。记录 CM 应用后 72 小时内的肌酐水平和院内结局。回顾性评估 RAAS 阻断对 CIN 频率的影响。

结果

共纳入 412 例患者（83.5%为男性，29.1%患有糖尿病，74.6%患有高血压）。其中 269 例（65.3%）患者正在服用 ACEI（n=236）或 AT-1 阻滞剂（n=33）。接受或未接受 RAAS 阻断治疗的患者之间的平均年龄（P=0.075）、肌酐水平（P=0.113）、性别（P=0.281）、糖尿病（P=0.172）或左心室射血分数（P=0.09）无显著差异。在接受或未接受 RAAS 阻断治疗的患者中，在 72 小时内发生 CIN 的单变量分析发现，接受 RAAS 阻断治疗的患者 CIN 发生率显著更高（11.9% vs 4.2%，P=0.006）。多变量分析（逻辑回归）确定 RAAS 阻断是 CIN 的独立预测因素（比值比 3.082，95%置信区间 1.234-7.698，P=0.016）。