Gerk U, Franke R P, Krüger-Genge A, Jung F
Städtisches Klinikum Dresden, II. Medizinische Klinik, Dresden, Germany.
Department of Biomaterials, Central Institute for Biomedical Technology, University of Ulm, Ulm, Germany.
Clin Hemorheol Microcirc. 2018;70(4):391-398. doi: 10.3233/CH-189304.
Contrast-induced acute kidney injury (CI-AKI), a potentially life-threatening complication of iodinated contrast media in patients with impaired renal function, has attracted increasing attention in recent years. There is overwhelming evidence that the most important pre-disposing factor for a contrast-medium induced nephropathy is the pre-existence of a renal impairment.
The registry was performed as a part of a quality management project in the Dresden-Friedrichstadt heart catheter laboratory. In compliance with the Declaration of Helsinki/Somerset West, 9,026 patients were included between 2010 and 2015. 100 patients of these were participants in a chronic dialysis program. All patients were dialyzed on the day before angiography. In all patients a coronary angiography, in 28 patients a stent implantation and in 12 patients a surgical reconstruction had to be performed. Prior to the intervention and one, two and three days thereafter the serum creatinine was measured.
Up to the third day after application of the iodinated contrast medium no significant changes of the serum creatinine (baseline value: 423.3±42.6μmol/l) occurred (ANOVA for repeated measures: p = 0.507). On average, a slight decrease of the serum creatinine was found.All patients remained in their routine dialysis-program. 18 out of 100 died during the next three months after the procedure.
The study revealed that the coronary angiography using Iodixanol as iodinated contrast medium did not result in an increase of serum creatinine, which was drastically elevated in these patients before application of the iodinated contrast medium.
对比剂诱导的急性肾损伤（CI-AKI）是肾功能受损患者使用碘化造影剂后可能危及生命的并发症，近年来受到越来越多的关注。有压倒性的证据表明，造影剂诱导的肾病最重要的易感因素是肾功能损害的预先存在。
该登记是德累斯顿-弗里德里希斯塔特心脏导管实验室质量管理项目的一部分。根据《赫尔辛基宣言》/萨默塞特韦斯特宣言，2010年至2015年期间纳入了9026例患者。其中100例患者参与了慢性透析项目。所有患者在血管造影前一天进行透析。所有患者均需进行冠状动脉造影，28例患者需进行支架植入，12例患者需进行手术重建。在干预前以及干预后1天、2天和3天测量血清肌酐。
在使用碘化造影剂后的第三天，血清肌酐（基线值：423.3±42.6μmol/l）没有显著变化（重复测量方差分析：p = 0.507）。平均而言，血清肌酐略有下降。所有患者均继续其常规透析项目。100例患者中有18例在术后接下来的三个月内死亡。
该研究表明，使用碘克沙醇作为碘化造影剂进行冠状动脉造影并未导致血清肌酐升高，而在使用碘化造影剂之前这些患者的血清肌酐大幅升高。
