Division of Internal Medicine, Mitsui Memorial Hospital, 1 Kanda-izumi-cho, Chiyoda-ku, Tokyo, 1018643, Japan.
Clin Exp Nephrol. 2019 Sep;23(9):1141-1146. doi: 10.1007/s10157-019-01751-4. Epub 2019 Jun 10.
Transcatheter arterial chemoembolization (TACE) is widely used for unresectable hepatocellular carcinoma (HCC). The purpose of this study was to investigate incidence and risk factors of contrast-induced nephropathy (CIN) after TACE in patients with HCC.
In this single-center retrospective study, we examined 461 consecutive TACE sessions in 260 patients between January 2003 and October 2015. CIN was defined as an increase in serum creatinine levels by ≥ 0.5 mg/dl or ≥ 25% from baseline within 72 h after TACE. We calculated incidence rate of CIN and tried to identify its risk factors by logistic regression analysis.
Twenty-one cases of CIN (5%) were observed in 461 TACE sessions. One patient required subsequent hemodialysis transiently. In univariate analysis, tumor size > 5 cm [odds ratio (OR) 5.76, 95% confidence interval (CI) 2.34-14.14, p < 0.001], chronic kidney disease (OR 2.54, 95% CI 1.05-6.14, p = 0.04), serum hemoglobin level [OR 0.79 (per 1 g/dl increase), 95% CI 0.64-0.98, p = 0.03] and serum albumin level [OR 0.44 (per 1 g/dl increase), 95% CI 0.19-1.02, p = 0.05] were associated with the development of CIN. Stepwise logistic regression methods showed that tumor size > 5 cm (OR 7.81, 95% CI 2.99-20.46, p < 0.001) and serum albumin [OR 0.29 (per 1 g/dl increase), 95% CI 0.11-0.75, p = 0.01] were risk factors of CIN.
In this study, HCC tumor size and lower serum albumin level were independent predictors of CIN after TACE.
经导管动脉化疗栓塞术（TACE）广泛用于不可切除的肝细胞癌（HCC）。本研究旨在探讨 HCC 患者 TACE 后对比剂诱导肾病（CIN）的发生率和危险因素。
在这项单中心回顾性研究中，我们检查了 2003 年 1 月至 2015 年 10 月期间 260 例患者的 461 例连续 TACE 疗程。CIN 定义为 TACE 后 72 小时内血清肌酐水平升高≥0.5mg/dl 或≥25%基线值。我们通过逻辑回归分析计算 CIN 的发生率，并尝试确定其危险因素。
在 461 次 TACE 中观察到 21 例 CIN（5%）。1 例患者需要短暂的后续血液透析。在单因素分析中，肿瘤大小>5cm[比值比（OR）5.76，95%置信区间（CI）2.34-14.14，p<0.001]、慢性肾脏病（OR 2.54，95%CI 1.05-6.14，p=0.04）、血清血红蛋白水平[OR 0.79（每增加 1g/dl），95%CI 0.64-0.98，p=0.03]和血清白蛋白水平[OR 0.44（每增加 1g/dl），95%CI 0.19-1.02，p=0.05]与 CIN 的发生相关。逐步逻辑回归方法显示，肿瘤大小>5cm（OR 7.81，95%CI 2.99-20.46，p<0.001）和血清白蛋白[OR 0.29（每增加 1g/dl），95%CI 0.11-0.75，p=0.01]是 CIN 的危险因素。
在这项研究中，HCC 肿瘤大小和较低的血清白蛋白水平是 TACE 后 CIN 的独立预测因素。
