蛋白尿和估算肾小球滤过率降低是心脏导管插入术后造影剂所致肾病的独立危险因素。

Proteinuria and Reduced Estimated Glomerular Filtration Rate Are Independent Risk Factors for Contrast-Induced Nephropathy After Cardiac Catheterization.

作者信息

Saito Yoshihiko, Watanabe Makoto, Aonuma Kazutaka, Hirayama Atsushi, Tamaki Nagara, Tsutsui Hiroyuki, Murohara Toyoaki, Ogawa Hisao, Akasaka Takashi, Yoshimura Michihiro, Sato Akira, Takayama Tadateru, Sakakibara Mamoru, Suzuki Susumu, Ishigami Kenichi, Onoue Kenji

机构信息

First Department of Internal Medicine, Nara Medical University.

出版信息

Circ J. 2015;79(7):1624-30. doi: 10.1253/circj.CJ-14-1345. Epub 2015 Apr 17.

DOI:10.1253/circj.CJ-14-1345

PMID:25891891

Abstract

BACKGROUND

The aim of this study was to investigate the incidence of contrast-induced nephropathy (CIN) according to renal function in patients with or without proteinuria after cardiac catheterization in Japan. METHODS AND RESULTS: We conducted a multicenter prospective observational study involving 27 hospitals from all over Japan, which enrolled 906 patients with cardiac catheterization. CIN was defined as increase in serum creatinine ≥0.5 mg/dl or ≥25% from baseline between 48 and 72 h after exposure to contrast. The incidence of CIN in patients with estimated glomerular filtration rate (eGFR) <30 ml/min/1.73 mwas significantly higher than that in patients with eGFR ≥60 ml/min/1.73 m. In patients without proteinuria, the incidence of CIN did not increase as eGFR decreased, but such a trend was observed in patients with proteinuria. Proteinuria was highly significantly associated with CIN in patients with eGFR 30-44 ml/min/1.73 m(OR, 12.1; 95% CI: 2.81-82.8; P=0.0006) and eGFR <30 ml/min/1.73 m(OR, 17.4; 95% CI: 3.32-321; P=0.0001). On multivariate logistic regression analysis, proteinuria (OR, 4.09; 95% CI: 1.66-10.0), eGFR (OR, 1.02; 95% CI: 1.00-1.04), contrast volume/eGFR (OR, 1.31; 95% CI: 1.04-1.65), and Ca antagonist use (OR, 3.79; 95% CI: 1.52-10.8) were significant predictors of CIN.

CONCLUSIONS

Proteinuria and reduced eGFR are independent risk factors for CIN after cardiac catheterization.

摘要

背景

本研究旨在调查日本接受心脏导管插入术的患者中，根据肾功能情况，有无蛋白尿患者对比剂肾病（CIN）的发生率。

方法与结果

我们进行了一项多中心前瞻性观察研究，涉及日本各地的27家医院，共纳入906例接受心脏导管插入术的患者。CIN定义为在接触对比剂后48至72小时内，血清肌酐较基线水平升高≥0.5mg/dl或≥25%。估算肾小球滤过率（eGFR）<30ml/min/1.73m²的患者中CIN的发生率显著高于eGFR≥60ml/min/1.73m²的患者。在无蛋白尿的患者中，CIN的发生率并未随eGFR降低而增加，但在有蛋白尿的患者中观察到了这种趋势。在eGFR为30 - 44ml/min/1.73m²（比值比[OR]，12.1；95%置信区间[CI]：2.81 - 82.8；P = 0.0006）和eGFR<30ml/min/1.73m²（OR，17.4；95% CI：3.32 - 321；P = 0.0001）的患者中，蛋白尿与CIN高度显著相关。多因素逻辑回归分析显示，蛋白尿（OR，4.09；95% CI：1.66 - 10.0）、eGFR（OR，1.02；95% CI：1.00 - 1.04）、对比剂用量/eGFR（OR，1.31；95% CI：1.04 - 1.65）以及使用钙拮抗剂（OR，3.79；95% CI：1.52 - 10.8）是CIN的显著预测因素。