预测普通患者人群在静脉注射碘造影剂增强计算机断层扫描中的肾脏疾病的存在。
Prediction of presence of kidney disease in a general patient population undergoing intravenous iodinated contrast enhanced computed tomography.
机构信息
Department of Radiology, G1-215, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands,
出版信息
Eur Radiol. 2014 Jun;24(6):1266-75. doi: 10.1007/s00330-014-3149-2. Epub 2014 Mar 25.
OBJECTIVE
To assess which risk factors can be used to reduce superfluous estimated glomerular filtration rate (eGFR) measurements before intravenous contrast medium administration.
METHODS
In consecutive patients, all decreased eGFR risk factors were assessed: diabetes mellitus (DM), history of urologic/nephrologic disease (HUND), nephrotoxic medication, cardiovascular disease, hypertension, age > 60 years, anaemia, malignancy and multiple myeloma/M. Waldenström. We studied four models: (1) all risk factors, (2) DM, HUND, hypertension, age > 60 years; (3) DM, HUND, cardiovascular disease, hypertension; (4) DM, HUND, age > 75 years and congestive heart failure. For each model, association with eGFR < 60 ml/min/1.73 m(2) or eGFR < 45 ml/min/1.73 m(2) was studied.
RESULTS
A total of 998 patients, mean age 59.94 years were included; 112 with eGFR < 60 ml/min/1.73 m(2) and 30 with eGFR < 45 ml/min/1.73 m(2). Model 1 detected 816 patients: 108 with eGFR < 60 ml/min/1.73 m(2) and all 30 with eGFR < 45 ml/min/1.73 m(2). Model 2 detected 745 patients: 108 with eGFR < 60 ml/min/1.73 m(2) and all 30 with eGFR < 45 ml/min/1.73 m(2). Model 3 detected 622 patients: 100 with eGFR < 60 ml/min/1.73 m(2) and all 30 with eGFR < 45 ml/min/1.73 m(2). Model 4 detected 440 patients: 86 with eGFR < 60 ml/min/1.73 m(2) and all 30 with eGFR < 45 ml/min/1.73 m(2). Associations were significant (p < 0.001).
CONCLUSION
Model 4 is most effective, resulting in the lowest proportion of superfluous eGFR measurements while detecting all patients with eGFR < 45 ml/min/1.73 m(2) and most with eGFR < 60 ml/min/1.73 m(2).
KEY POINTS
A major risk factor for contrast-induced nephropathy (CIN) is kidney disease. Risk factors are used to identify patients with pre-existent kidney disease. Evidence for risk factors to identify patients with kidney disease is limited. The number of eGFR measurements to detect kidney disease can be reduced.
目的
评估哪些风险因素可用于减少静脉内造影剂给药前多余的估算肾小球滤过率（eGFR）测量。
方法
在连续患者中，评估所有降低 eGFR 的风险因素：糖尿病（DM）、泌尿系统/肾脏疾病史（HUND）、肾毒性药物、心血管疾病、高血压、年龄>60 岁、贫血、恶性肿瘤和多发性骨髓瘤/M. Waldenström。我们研究了四个模型：（1）所有风险因素；（2）DM、HUND、高血压、年龄>60 岁；（3）DM、HUND、心血管疾病、高血压；（4）DM、HUND、年龄>75 岁和充血性心力衰竭。对于每个模型，研究与 eGFR<60 ml/min/1.73 m(2)或 eGFR<45 ml/min/1.73 m(2)的关联。
结果
共纳入 998 例患者，平均年龄 59.94 岁；112 例 eGFR<60 ml/min/1.73 m(2)，30 例 eGFR<45 ml/min/1.73 m(2)。模型 1 检测到 816 例患者：108 例 eGFR<60 ml/min/1.73 m(2)，30 例 eGFR<45 ml/min/1.73 m(2)。模型 2 检测到 745 例患者：108 例 eGFR<60 ml/min/1.73 m(2)，30 例 eGFR<45 ml/min/1.73 m(2)。模型 3 检测到 622 例患者：100 例 eGFR<60 ml/min/1.73 m(2)，30 例 eGFR<45 ml/min/1.73 m(2)。模型 4 检测到 440 例患者：86 例 eGFR<60 ml/min/1.73 m(2)，30 例 eGFR<45 ml/min/1.73 m(2)。关联均具有统计学意义（p<0.001）。
结论
模型 4 最有效，在检测所有 eGFR<45 ml/min/1.73 m(2)和大多数 eGFR<60 ml/min/1.73 m(2)患者的同时，导致多余 eGFR 测量的比例最低。
关键点
造影剂肾病（CIN）的一个主要危险因素是肾脏疾病。风险因素用于识别存在先前存在的肾脏疾病的患者。用于识别患有肾脏疾病的患者的风险因素的证据有限。可以减少检测肾脏疾病的 eGFR 测量次数。
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