Department of Oncology, Tainan Hospital, Ministry of Health and Welfare, Executive Yuan, No. 125, Jhongshan Rd, Tainan City 70043, Taiwan, ROC.
Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan, ROC.
AJR Am J Roentgenol. 2019 Oct;213(4):728-735. doi: 10.2214/AJR.19.21309. Epub 2019 Aug 6.
Contrast-induced nephropathy (CIN) generally is the main concern for patients with chronic kidney disease (CKD) undergoing contrast-enhanced imaging. To evaluate the risk of nephropathy induced by IV contrast medium (CM) in patients with CKD, we performed a meta-analysis. We searched for PubMed and MEDLINE articles that were published up to October 3, 2018, contained the phrase "contrast medium" or "contrast media" and the word "renal," and included patients with CKD and a proper control group. The publications that were identified were reviewed, and only studies that used an IV route of CM administration were selected. Subgroup analysis was performed according to the estimated glomerular filtration rate. Six studies including 55,963 participants were selected. The Peto method and random-effects model were applied. IV infusion of CM did not lead to the deterioration of renal function in patients with CKD compared with those without CKD (odds ratio [OR], 1.07; 95% CI, 0.98-1.17; , 35.3%). As the estimated glomerular filtration rate decreased, fewer patients received IV CM. The ORs for CIN on the basis of CKD stage were as follows: 1.11 (95% CI, 0.95-1.30; , 4.0%) for stage 2 CKD, 1.05 (95% CI, 0.93-1.18, , 48.3%) for CKD lower than stage 3, 1.06 (95% CI, 0.94-1.19; , 32.0%) for stage 3 CKD, 1.08 (95% CI, 0.84-1.39; , 44.6%) for CKD lower than stage 4, 0.86 (95% CI, 0.37-2.00) for stage 4 CKD, and 0.26 (95% CI, 0.02-3.4) for stage 5 CKD in one study only. All analyses showed the lack of difference in the ORs for CIN between participants who received IV injection of CM and those who did not. Retrospective cohort studies of IV radiographic CM have failed to show renal damage in patients with CKD. This retrospective study is limited, and other risk factors for CIN might not be distributed evenly.
对比剂肾病（CIN）通常是慢性肾脏病（CKD）患者接受增强成像的主要关注点。为了评估 CKD 患者静脉内造影剂（CM）引起肾病的风险，我们进行了一项荟萃分析。我们搜索了截至 2018 年 10 月 3 日发表的包含“造影剂”或“造影剂”和“肾脏”字样的 PubMed 和 MEDLINE 文章，并纳入了 CKD 患者和适当对照组的研究。对确定的出版物进行了审查，仅选择了使用静脉内 CM 给药途径的研究。根据估计的肾小球滤过率进行了亚组分析。纳入了 6 项研究共 55963 名参与者。应用 Peto 方法和随机效应模型。与无 CKD 患者相比，静脉内输注 CM 并未导致 CKD 患者肾功能恶化（比值比 [OR]，1.07；95%置信区间，0.98-1.17；I2=35.3%）。随着估计肾小球滤过率的降低，接受静脉内 CM 的患者减少。基于 CKD 分期的 CIN 的 OR 如下：CKD 2 期为 1.11（95%置信区间，0.95-1.30；I2=4.0%），CKD 低于 3 期为 1.05（95%置信区间，0.93-1.18；I2=48.3%），CKD 3 期为 1.06（95%置信区间，0.94-1.19；I2=32.0%），CKD 低于 4 期为 1.08（95%置信区间，0.84-1.39；I2=44.6%），CKD 4 期为 0.86（95%置信区间，0.37-2.00），而在一项研究中仅为 0.26（95%置信区间，0.02-3.4）。所有分析均显示，接受静脉内注射 CM 的参与者与未接受者的 CIN OR 无差异。静脉放射造影 CM 的回顾性队列研究未能显示 CKD 患者的肾损害。这项回顾性研究是有限的，CIN 的其他危险因素可能分布不均。
