Fukushima Yasuhiro, Miyazawa Hitomi, Nakamura Junpei, Taketomi-Takahashi Ayako, Suto Takayuki, Tsushima Yoshito
Department of Radiology, Gunma University Hospital, 3-39-15 Showa, Maebashi, Gunma, 371-8511, Japan.
Division of Clinical Radiology Service, Kyoto University Hospital, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
Jpn J Radiol. 2017 Aug;35(8):427-431. doi: 10.1007/s11604-017-0649-4. Epub 2017 May 20.
To investigate the incidence and risk factors of contrast induced nephropathy (CIN) after contrast enhanced (CE) computed tomography (CT) in patients with renal dysfunction.
Two hundred sixteen inpatients with estimated glomerular filtration rates (eGFR) <60 ml/min/1.73 m underwent CE CT using iodine doses of 420 or 480 mg I/kg. Data of all enrolled patients was collected for baseline serum creatinine level (SCr), post-CE CT SCr within 3 days after CE CT, and conditions considered risk factors for CIN [renal dysfunction, contrast media dose, advanced age, diabetes mellitus, no intravenous hydration, cardiac dysfunction (left ventricular ejection fraction <60%) and intensive-care unit (ICU) admission]. CIN was defined as an increase in SCr level of more than 0.5 mg/dl or more than 25% from baseline within 3 days post-CE CT without any other identifiable cause of acute kidney injury.
The incidence of CIN was 11/216 (5.1%) and was associated with cardiac dysfunction [odds ratio (OR) 6.540; 95% confidence interval (CI) 1.090-39.300; p = 0.040] and ICU admission (OR 11.500; 95% CI 2.050-64.100; p = 0.005).
Our results suggested that cardiac dysfunction and ICU admission may be risk factors for CIN in patients with preexisting renal dysfunction.
探讨肾功能不全患者在对比增强计算机断层扫描（CT）后对比剂肾病（CIN）的发生率及危险因素。
216例估计肾小球滤过率（eGFR）<60 ml/min/1.73 m²的住院患者接受了碘剂量为420或480 mg I/kg的对比增强CT检查。收集所有入组患者的基线血清肌酐水平（SCr）、对比增强CT后3天内的对比增强CT后SCr以及被认为是CIN危险因素的情况[肾功能不全、造影剂剂量、高龄、糖尿病、无静脉补液、心功能不全（左心室射血分数<60%）和入住重症监护病房（ICU）]。CIN定义为对比增强CT后3天内SCr水平较基线升高超过0.5 mg/dl或超过25%，且无其他可识别的急性肾损伤原因。
CIN的发生率为11/216（5.1%），与心功能不全[比值比（OR）6.540；95%置信区间（CI）1.090 - 39.300；p = 0.040]和入住ICU（OR 11.500；95% CI 2.050 - 64.100；p = 0.005）相关。
我们的结果表明，心功能不全和入住ICU可能是已有肾功能不全患者发生CIN的危险因素。
