Department of Internal Medicine, Aging and Renal Disease-Section of Nephrology, University of Bologna, Bologna, Italy.
Artif Organs. 2010 Jun;34(6):E193-9. doi: 10.1111/j.1525-1594.2009.00984.x. Epub 2010 May 7.
Among the causes of in-hospital acute renal failure, contrast-induced nephropathy ranks third in prevalence. Although it represents a condition of renal impairment with spontaneous recovery, contrast nephropathy should always be considered, because it prolongs hospitalization and it may become a severe complication requiring dialysis. The purposes of this study are: (i) to determine if the application of the most effective contrast-induced nephropathy prevention strategies in the Cardiology Intensive Care Unit can prove to be successful in reducing nephropathy risk; and (ii) to identify which of the involved risk factors persist after the preventive treatment. We examined the patients who had a coronarography at the Bentivoglio hospital from April 2007 to April 2008 who required at least 3 days of permanence in hospital due to the presence of potential risk factors; 136 out of 784 patients were included. Among the selected patients, 21 (15.44%) developed a renal impairment compatible with contrast-induced nephropathy. The risk factors that seemed to display the best correlation with risk of contrast nephropathy were advanced age and an ventricular failure (ejection fraction <40%); however, the critical condition did not appear to be due to a single risk factor, but it resulted from the association of more contextual risk factors. Particularly, the concomitant presence of ventricular failure, anemia, diabetes, previous myocardial infarction and advanced age (>70 years) determined a threefold increased risk of contrast nephropathy. Our data suggest that the development of contrast nephropathy following coronarography is associated with worse renal function during hospitalization and at discharge.
在院内急性肾衰竭的病因中，造影剂肾病的发病率位居第三。虽然造影剂肾病是一种可自发恢复的肾功能损害，但仍应考虑到这种疾病，因为它会延长住院时间，并可能成为需要透析的严重并发症。本研究的目的是：(i) 确定在心脏病重症监护病房（Cardiology Intensive Care Unit）应用最有效的造影剂肾病预防策略是否能成功降低肾病风险；(ii) 确定在预防治疗后哪些相关风险因素仍然存在。我们对 2007 年 4 月至 2008 年 4 月在 Bentivoglio 医院进行冠状动脉造影检查、因存在潜在风险因素而需要至少 3 天住院的患者进行了检查，共纳入 784 例患者中的 136 例。在所选择的患者中，有 21 例（15.44%）发生了与造影剂肾病相符的肾功能损害。与造影剂肾病风险相关性最好的风险因素似乎是高龄和心力衰竭（射血分数<40%）；然而，危急状况似乎不是由单一风险因素引起的，而是由更多的相关风险因素共同作用所致。特别是，心力衰竭、贫血、糖尿病、既往心肌梗死和高龄（>70 岁）同时存在会使造影剂肾病的风险增加三倍。我们的数据表明，冠状动脉造影后造影剂肾病的发生与住院期间和出院时的肾功能更差有关。
