Caruso Marco, Balasus Fabio, Incalcaterra Egle, Ruggieri Aldo, Evola Salvatore, Fattouch Khalil, Bracale Umberto M, Amodio Emanuele, Novo Giuseppina, Andolina Giuseppe, Novo Salvatore
Cardiology Unit, University of Palermo, Italy.
Intern Med. 2011;50(9):983-9. doi: 10.2169/internalmedicine.50.4976. Epub 2011 May 1.
To compare the incidence, and risk factors, in-hospital and at the 18-month prognosis of contrast-induced nephropathy (CIN) according to the definition utilized: as an increase in serum creatinine (Scr) ≥ 0.5 mg/dL (CIN 1) or as an increase in Scr ≥ 25% above baseline values (CIN 2).
We prospectively evaluated CIN according to two different definitions in 150 patients who underwent percutaneous coronary intervention (PCI) in simple lesions employing a low-medium dose of contrast media. Incidence of CIN was higher using the CIN 2 definition than CIN 1 (9.3% vs. 4%; p=0.0133). Patients with CIN 1 had a higher incidence of chronic kidney disease (CKD) (66.7% vs. 13.9%; p=0.006), higher mean serum creatinine levels (1.35±0.42 vs. 0.98±0.35; p=0.001) and lower mean eGFR levels (58.3±19.6 vs. 84±25.9; p=0.002). Patients with CIN 2 had a higher incidence of anemia (57.1% vs. 30.9%; p=0.049) and a higher mean contrast media volume was used (142.6±62.2 mL vs. 110.6±57.2 mL; p=0.05). In the multivariate analysis the only significant variable associated with CIN (CIN 2) was a higher volume of contrast media (OR=1.01; p=0.04). There were no differences in the major in-hospital events, but patients with CIN (both definitions) had a longer in-hospital stay. A persistent rise in serum creatinine at discharge occurred in only one patient. There were no differences between patients with and without CIN in events at the follow-up, with the exception of an increased risk of new hospitalization in patients with CIN 2.
After PCI employing low-medium dose of contrast media the incidence of CIN varied according to the definition used. Neither of the two definitions offers additional information compared with the other. Chronic kidney disease and baseline parameters of renal function are the risk factors associated with CIN 1; anemia and higher volume of contrast media are associated with CIN 2.
根据所采用的定义比较对比剂肾病（CIN）的发生率、危险因素、住院期间及18个月预后情况，定义为血清肌酐（Scr）升高≥0.5mg/dL（CIN 1）或Scr升高超过基线值≥25%（CIN 2）。
我们前瞻性地根据两种不同定义评估了150例在简单病变中接受低-中剂量造影剂经皮冠状动脉介入治疗（PCI）的患者的CIN情况。采用CIN 2定义时CIN的发生率高于CIN 1（9.3%对4%；p=0.0133）。CIN 1患者慢性肾脏病（CKD）的发生率更高（66.7%对13.9%；p=0.006），平均血清肌酐水平更高（1.35±0.42对0.98±0.35；p=0.001），平均估算肾小球滤过率（eGFR）水平更低（58.3±19.6对84±25.9；p=0.002）。CIN 2患者贫血的发生率更高（57.1%对30.9%；p=0.049），使用的造影剂平均剂量更高（142.6±62.2mL对110.6±57.2mL；p=0.05）。在多变量分析中，与CIN（CIN 2）相关的唯一显著变量是更高的造影剂剂量（比值比=1.01；p=0.04）。主要住院事件无差异，但CIN患者（两种定义）住院时间更长。出院时仅1例患者血清肌酐持续升高。随访时CIN患者与非CIN患者在事件方面无差异，但CIN 2患者再次住院风险增加除外。
在使用低-中剂量造影剂进行PCI后，CIN的发生率因所用定义而异。两种定义相比，均未提供额外信息。慢性肾脏病和肾功能基线参数是与CIN 1相关的危险因素；贫血和更高的造影剂剂量与CIN 2相关。
