Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
Acad Radiol. 2012 Oct;19(10):1181-5. doi: 10.1016/j.acra.2012.04.016. Epub 2012 Jul 24.
The Food and Drug Administration recommends renal function estimation using laboratory testing for patients at risk for chronically reduced kidney function before the administration of gadolinium-based contrast agents (GBCAs). Point-of-care (POC) estimated glomerular filtration rate (eGFR) testing was added to the pre-magnetic resonance (MR) questionnaire at our institution in June 2008 for all patients undergoing a contrast-enhanced MR exam. This study was done to evaluate the effectiveness of a pre-MR screening questionnaire about kidney disease and to assess POC eGFR detection of additional patients at risk for nephrogenic systemic fibrosis.
This retrospective study was approved by our institutional review board and determined to be Health Insurance Portability and Accountability Act compliant. Medical records, laboratory data, and pre-MR questionnaires of all patients who presented for contrast-enhanced MR scans during October 2008 were reviewed. The National Kidney Disease Education Program isotope-dilution mass spectrometry-traceable Modification of Diet in Renal Disease equation was used to calculate eGFRs using the POC creatinine laboratory value, age, race, and gender. Sensitivity and specificity were calculated using 2 × 2 tables, and 95% confidence intervals were calculated with exact binomial confidence intervals.
A total of 1167 individuals presented for contrast-enhanced MR scans. Of 13 individuals on dialysis, 2 did not report renal disease. Of 1154 individuals not on dialysis, 25 had an eGFR <30 mL/min/1.73 m(2) (95% CI 1.41%-3.18%). Of these 25, 13 did and 12 did not report renal disease. The sensitivity of the questionnaire for identifying patients with an eGFR <30 mL/min/1.73 m(2) was 63.2%. POC eGFR estimations identified a prevalence of 2.17% (95% CI: 1.41%-3.18%) of the total individuals not on dialysis, with an eGFR <30 mL/min/1.73 m(2). Patients who denied kidney dysfunction had a 1.08% (95% CI: 0.56%-1.88%) posttest probability of having an eGFR <30 mL/min/1.73 m(2).
POC eGFR testing identified a significant number of individuals with renal dysfunction not found by the pre-MR imaging questionnaire alone.
美国食品和药物管理局建议在使用钆基造影剂（GBCA）之前，对有慢性肾功能降低风险的患者使用实验室检测来估计肾功能。我们机构在 2008 年 6 月在进行对比增强磁共振检查的所有患者的磁共振前问卷中添加了即时（POC）估算肾小球滤过率（eGFR）检测。这项研究旨在评估一份关于肾脏疾病的磁共振前筛查问卷的有效性，并评估 POC eGFR 是否可以发现更多有肾源性系统性纤维化风险的患者。
这项回顾性研究获得了我们机构审查委员会的批准，并被确定符合《健康保险流通与责任法案》的规定。回顾了 2008 年 10 月期间所有进行对比增强磁共振扫描的患者的病历、实验室数据和磁共振前问卷。使用即时肌酐实验室值、年龄、种族和性别，使用肾脏病饮食改良试验同位素稀释质谱追踪法计算 eGFR。使用 2×2 表计算敏感性和特异性，并使用精确二项式置信区间计算 95%置信区间。
共有 1167 人进行了对比增强磁共振扫描。在 13 名透析患者中，有 2 名未报告肾脏疾病。在 1154 名非透析患者中，有 25 名 eGFR<30ml/min/1.73m²（95%CI 1.41%-3.18%）。在这 25 名患者中，有 13 名报告了肾脏疾病，有 12 名没有报告。问卷识别 eGFR<30ml/min/1.73m²患者的敏感性为 63.2%。POC eGFR 估计值在非透析的所有患者中识别出 2.17%（95%CI：1.41%-3.18%）的患病率，eGFR<30ml/min/1.73m²。否认肾脏功能障碍的患者 eGFR<30ml/min/1.73m²的后验概率为 1.08%（95%CI：0.56%-1.88%）。
POC eGFR 检测发现了大量仅通过磁共振前成像问卷无法发现的肾功能障碍患者。
