Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, USA.
Circ Cardiovasc Interv. 2010 Aug;3(4):346-50. doi: 10.1161/CIRCINTERVENTIONS.109.910638. Epub 2010 Jun 29.
Previous work on contrast-induced acute kidney injury (CI-AKI) has identified contrast volume as a risk factor and suggested that there is a maximum allowable contrast dose (MACD) above which the risk of CI-AKI is markedly increased. We hypothesized that there is a relationship between contrast volume and CI-AKI and that there might be reason to track incremental contrast volumes above and below the MACD limit.
Consecutive patients undergoing percutaneous coronary intervention (PCI) were prospectively enrolled from 2000 to 2008 (n=10 065). Patients on dialysis before PCI were excluded (n=155). MACD was defined as (5 mL x body weight [kg])/baseline serum creatinine [mg/dL]) and divided into categories in which 1.0 reflects the MACD limit: < or =MACD ratios (<0.5, 0.5 to 0.75, and 0.75 to 1.0) and >MACD (1.0 to 1.5, 1.5 to 2.0, and >2.0). CI-AKI was defined as a > or =0.3 (mg/dL) or > or =50% increase in serum creatinine from baseline or new dialysis. Multivariable regression was conducted to evaluate the effect of exceeding the MACD on CI-AKI. Twenty percent of patients exceeded the MACD. Risk-adjusted CI-AKI increased by an average of 45% for each category exceeding the MACD (odds ratio, 1.45; 95% confidence interval, 1.29 to 1.62) Adjusted odds ratios for each category exceeding the MACD were 1.60 (95% confidence interval, 1.29 to 1.97), 2.02 (95% confidence interval, 1.45 to 2.81), and 2.94 (95% confidence interval, 1.93 to 4.48). CI-AKI for contrast dose <MACD showed no statistical difference (P=0.5).
Contrast volume is a key risk factor for CI-AKI and matters the most in the highest-risk patient. The incremental use of contrast beyond the MACD is associated with an increased risk of CI-AKI.
先前关于对比剂诱导急性肾损伤（CI-AKI）的研究已经确定了对比剂用量是一个危险因素，并提出了存在一个允许的最大对比剂剂量（MACD），超过该剂量，CI-AKI 的风险会显著增加。我们假设对比剂用量与 CI-AKI 之间存在关系，并且可能有理由跟踪 MACD 限制以上和以下的增量对比剂用量。
连续接受经皮冠状动脉介入治疗（PCI）的患者于 2000 年至 2008 年前瞻性纳入（n=10065）。排除了 PCI 前接受透析的患者（n=155）。MACD 定义为（5mL x 体重[kg]）/基线血清肌酐[mg/dL]），并分为以下类别：<或=MACD 比值（<0.5、0.5 至 0.75 和 0.75 至 1.0）和>MACD（1.0 至 1.5、1.5 至 2.0 和>2.0）。CI-AKI 定义为血清肌酐从基线升高>或=0.3（mg/dL）或>或=50%或新透析。进行多变量回归以评估超过 MACD 对 CI-AKI 的影响。20%的患者超过了 MACD。超过 MACD 的每个类别平均使 CI-AKI 风险增加 45%（优势比，1.45；95%置信区间，1.29 至 1.62）。超过 MACD 的每个类别调整后的优势比分别为 1.60（95%置信区间，1.29 至 1.97）、2.02（95%置信区间，1.45 至 2.81）和 2.94（95%置信区间，1.93 至 4.48）。对比剂量<MACD 的 CI-AKI 无统计学差异（P=0.5）。
对比剂用量是 CI-AKI 的关键危险因素，在风险最高的患者中最为重要。超过 MACD 的增量使用对比剂与 CI-AKI 风险增加相关。
