Park Sehoon, Kim Myoung-Hee, Kang Eunjeong, Park Seokwoo, Jo Hyung Ah, Lee Hajeong, Kim Sun Moon, Lee Jung Pyo, Oh Kook-Hwan, Joo Kwon Wook, Kim Yon Su, Kim Dong Ki
From the Department of Internal Medicine, Seoul National University College of Medicine, Seoul (SP, EK, SP, HAJ, HL, K-HO, KWJ, YSK, DKK); Department of Dental Hygiene, College of Health Science, Eulji University, Gyeonggi-do (M-HK); Department of Internal Medicine, Chungbuk National University Hospital, Chungcheongbuk-do (SMK); Department of Internal Medicine, Seoul National University Boramae Medical Center (JPL); and Kidney Research Institute, Seoul National University, Seoul, Korea (KWJ, YSK, DKK).
Medicine (Baltimore). 2016 May;95(18):e3560. doi: 10.1097/MD.0000000000003560.
Conflicting data have been reported on the clinical significance of contrast-induced nephropathy after CT scan (CT-CIN). In addition, the epidemiologic characteristics and clinical outcomes of CT-CIN following proper prophylactic intervention remain elusive.We examined the incidence, risk factors, and outcomes of CT-CIN in stable chronic kidney disease (CKD) patients using data collected from our outpatient CT-CIN prophylaxis program conducted between 2007 and 2014. The program recruited patients with an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m using an electronic health record-based pop-up alert system and provided an identical protocol of CIN prophylaxis to all patients.A total of 1666 subjects were included in this study, and 61 of the 1666 subjects (3.7%) developed CT-CIN. Multivariate analysis showed that baseline eGFR, diabetes mellitus, and low serum albumin were significant risk factors for CT-CIN. The generalized additive model analysis revealed a nonlinear relationship between the baseline eGFR and the risk of CT-CIN. In this analysis, the risk of CT-CIN began to increase below an eGFR threshold of 36.8 mL/min/1.73 m. To assess the outcomes of CT-CIN, patients with and without CT-CIN were compared after propensity score-based 1:2 matching. CT-CIN did not increase the mortality rate of patients. However, patients with CT-CIN were significantly more likely to start dialysis within 6 months of follow-up, but not after those initial 6 months.CT-CIN developed in only a small number of stable CKD patients who received proper prophylactic intervention, and the risk of CT-CIN was increased in patients with more advanced CKD. Despite the low incidence, CT-CIN conferred a non-negligible risk for the initiation of dialysis in the acute period, even after prophylaxis.
关于CT扫描后对比剂肾病（CT-CIN）的临床意义，已有相互矛盾的数据报道。此外，适当预防性干预后CT-CIN的流行病学特征和临床结局仍不明确。我们利用2007年至2014年期间我们门诊CT-CIN预防项目收集的数据，研究了稳定期慢性肾脏病（CKD）患者中CT-CIN的发生率、危险因素和结局。该项目使用基于电子健康记录的弹出式警报系统招募估计肾小球滤过率（eGFR）<60 mL/min/1.73 m²的患者，并为所有患者提供相同的CIN预防方案。
本研究共纳入1666名受试者，其中1666名受试者中有61名（3.7%）发生了CT-CIN。多变量分析显示，基线eGFR、糖尿病和低血清白蛋白是CT-CIN的显著危险因素。广义相加模型分析显示基线eGFR与CT-CIN风险之间存在非线性关系。在此分析中，当eGFR阈值低于36.8 mL/min/1.73 m²时，CT-CIN风险开始增加。为了评估CT-CIN的结局，在基于倾向评分的1:2匹配后，对发生和未发生CT-CIN的患者进行了比较。CT-CIN并未增加患者的死亡率。然而，发生CT-CIN的患者在随访6个月内开始透析的可能性显著更高，但在最初6个月之后则不然。
在接受适当预防性干预的少数稳定CKD患者中发生了CT-CIN，且CKD病情越严重的患者发生CT-CIN的风险越高。尽管发生率较低，但即使在进行预防后，CT-CIN在急性期仍会给开始透析带来不可忽视的风险。
