Department of Surgery, Michael E. DeBakey VA Medical Center, Houston, Tex; Department of Surgery, Baylor College of Medicine, Houston, Tex.
Department of Surgery, Michael E. DeBakey VA Medical Center, Houston, Tex.
J Vasc Surg. 2014 Jun;59(6):1644-50. doi: 10.1016/j.jvs.2013.12.039. Epub 2014 Feb 21.
Patients with occlusive or aneurysmal vascular disease are repeatedly exposed to intravascular (IV) contrast for diagnostic or therapeutic purposes. We sought to determine the long-term impact of cumulative iodinated IV contrast exposure (CIVCE) on renal function; the latter was defined by means of National Kidney Foundation (NKF) criteria.
We performed a longitudinal study of consecutive patients without renal insufficiency at baseline (NFK stage I or II) who underwent interventions for arterial occlusive or aneurysmal disease. We collected detailed data on any IV iodinated contrast exposure (including diagnostic or therapeutic angiography, cardiac catheterization, IV pyelography, computed tomography with IV contrast, computed tomographic angiography); medication exposure throughout the observation period; comorbidities; and demographics. The primary end point was the development of renal failure (RF) (defined as NFK stage 4 or 5). Analysis was performed with the use of a shared frailty model with clustering at the patient level.
Patients (n = 1274) had a mean follow-up of 5.8 (range, 2.2-14) years. In the multivariate model with RF as the dependent variable and after adjusting for the statistically significant covariates of baseline renal function (hazard ratio [HR], 0.95; P < .001), diabetes (HR, 1.8; P = .007), use of an angiotensin-converting enzyme inhibitor (HR, 0.63; P = .03), use of antiplatelets (HR, 0.5; P = .01), cumulative number of open vascular operations performed (HR, 1.2; P = .001), and congestive heart failure (HR, 3.2; P < .001), CIVCE remained an independent predictor for RF development (HR, 1.1; P < .001). In the multivariate survival analysis model and after adjusting for the statistically significant covariates of perioperative myocardial infarction (HR, 3.9; P < .001), age at entry in the cohort (HR, 1.05; P = .035), total number of open operations (HR, 1.51; P < .001), and serum albumin (HR, 0.47; P < .001), CIVCE was an independent predictor of death (HR, 1.07; P < .001).
Cumulative IV contrast exposure is an independent predictor of RF and death in patients with occlusive and aneurysmal vascular disease.
患有闭塞性或动脉瘤性血管疾病的患者因诊断或治疗目的而反复接受血管内（IV）造影剂。我们旨在确定累积碘 IV 造影剂暴露（CIVCE）对肾功能的长期影响；后者是通过国家肾脏基金会（NKF）标准定义的。
我们对基线时无肾功能不全（NFK 分期 I 或 II）的连续动脉闭塞或动脉瘤性疾病患者进行了一项纵向研究。我们收集了关于任何 IV 碘造影剂暴露（包括诊断性或治疗性血管造影、心导管检查、IV 肾盂造影、IV 对比增强 CT、CT 血管造影）的详细数据；整个观察期的药物暴露情况；合并症；以及人口统计学资料。主要终点是肾衰竭（RF）的发展（定义为 NFK 分期 4 或 5）。使用共享脆弱模型进行分析，患者水平聚类。
患者（n=1274）平均随访 5.8（范围 2.2-14）年。在将 RF 作为因变量的多变量模型中，并在调整了基线肾功能（危险比[HR]，0.95；P<0.001）、糖尿病（HR，1.8；P=0.007）、血管紧张素转换酶抑制剂（HR，0.63；P=0.03）、抗血小板药物（HR，0.5；P=0.01）、进行的开放性血管手术数量（HR，1.2；P=0.001）和充血性心力衰竭（HR，3.2；P<0.001）等有统计学意义的协变量后，CIVCE 仍然是 RF 发展的独立预测因素（HR，1.1；P<0.001）。在多变量生存分析模型中，并在调整了围手术期心肌梗死（HR，3.9；P<0.001）、队列入组时的年龄（HR，1.05；P=0.035）、总开放手术数量（HR，1.51；P<0.001）和血清白蛋白（HR，0.47；P<0.001）等有统计学意义的协变量后，CIVCE 是死亡的独立预测因素（HR，1.07；P<0.001）。
在患有闭塞性和动脉瘤性血管疾病的患者中，累积 IV 造影剂暴露是 RF 和死亡的独立预测因素。
