Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel ; Peritoneal Dialysis Unit, Galilee Medical Center, Nahariya, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Ther Clin Risk Manag. 2014 Oct 3;10:787-95. doi: 10.2147/TCRM.S70665. eCollection 2014.
Residual renal function (RRF) is an important predictor of outcome in peritoneal dialysis (PD) patients. Hypoalbuminemia was found to be an independent risk factor for the development of acute kidney injury. We investigated the possibility of an association between serum albumin levels and the development of iodine contrast media-induced nephropathy (CIN) in PD patients.
A total of 103 PD patients who underwent invasive angiographies with exposure to iodine contrast media (ICM) were reviewed retrospectively. All patients received 0.9% saline intravenously at a rate of 75 mL per hour for 12 hours prior, during, and 12 hours after exposure to ICM. Acetylcysteine was given orally at a dose of 600 mg twice daily, on the day before and on the day of exposure to ICM. The nonionic, low-osmolar contrast agent iopromide was used at a mean dose of 75.0±15.2 mL. The changes in RRF from baseline to 1 week and 4 weeks after exposure to ICM were recorded. Outcomes of patients with serum albumin levels <3.8 g/dL and those with serum albumin levels ≥3.8 g/dL were compared. A reduction >30% in RRF at 7 days after exposure to ICM was considered CIN.
CIN developed in 27.2% (28/103) of patients. Of the 103 patients, 59.2% (61) had serum albumin levels <3.8 g/dL. Of those, 37.7% (23/61) developed CIN, compared with 11.9% (5/42) of those with serum albumin levels ≥3.8 g/dL (P=0.004). After adjustment for all tested variables in a logistic regression with a stepwise selection model, serum albumin level at exposure to ICM was found to be the most powerful predictor of the development of CIN (odds ratio =4.5; confidence interval =1.5-13.0; P=0.006).
PD patients with serum albumin levels <3.8 g/dL should be monitored carefully when exposed to ICM. Serum albumin level may be considered a potential therapeutic target in the prevention of CIN and preservation of RRF in PD patients.
残余肾功能（RRF）是腹膜透析（PD）患者预后的重要预测因素。低白蛋白血症被认为是急性肾损伤发展的独立危险因素。我们研究了血清白蛋白水平与 PD 患者碘造影剂诱导肾病（CIN）发展之间的可能关联。
回顾性分析了 103 例接受碘造影剂（ICM）侵袭性血管造影的 PD 患者。所有患者在接受 ICM 暴露前、期间和暴露后 12 小时内以 75 mL/小时的速度静脉输注 0.9%生理盐水。乙酰半胱氨酸口服，剂量为 600 mg，每天两次，在接受 ICM 前一天和当天使用。使用非离子型、低渗造影剂碘普罗胺，平均剂量为 75.0±15.2 mL。记录 ICM 暴露后 1 周和 4 周时 RRF 的变化。比较血清白蛋白水平<3.8 g/dL 和血清白蛋白水平≥3.8 g/dL 的患者的结局。将 ICM 暴露后 7 天 RRF 降低>30%定义为 CIN。
27.2%（28/103）的患者发生 CIN。在 103 例患者中，59.2%（61）的血清白蛋白水平<3.8 g/dL。其中，37.7%（23/61）发生 CIN，而血清白蛋白水平≥3.8 g/dL 的患者中，这一比例为 11.9%（5/42）（P=0.004）。在校正了逐步选择模型的逻辑回归中的所有测试变量后，发现 ICM 暴露时的血清白蛋白水平是 CIN 发展的最强预测因素（比值比=4.5；置信区间=1.5-13.0；P=0.006）。
血清白蛋白水平<3.8 g/dL 的 PD 患者在接受 ICM 时应密切监测。血清白蛋白水平可能是预防 CIN 和保留 PD 患者 RRF 的潜在治疗靶点。
