Clinical Division of Nephrology, Department of Internal Medicine, Medical University of Graz (MUG), Graz, Austria.
Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria.
Sci Rep. 2019 Nov 15;9(1):16896. doi: 10.1038/s41598-019-53040-5.
The existence and clinical relevance of contrast induced acute kidney injury (CI-AKI) is still heavily debated and angiographic procedures are often withheld in fear of CI-AKI, especially in CKD-patients. We investigated the incidence of CI-AKI in cardiovascular high risk patients undergoing intra-arterial angiography and its impact on mid-term kidney function, cardiovascular events and mortality. We conducted a prospective observational trial on patients undergoing planned intra-arterial angiographic procedures. All subjects received standardized intravenous hydration prior to contrast application. CI-AKI was defined according to a ≥25% increase of creatinine from baseline to either 24hrs or 48hrs after angiography. Plasma creatinine and eGFR were recorded from the institutional medical record system one and three months after hospital discharge. Patients were followed up for two years to investigate the long term effects of CI-AKI on cardiovascular events and mortality. We studied 706 (317 female) patients with a mean eGFR of 52.0 ± 15 ml·min·1.73 m. The incidence of CI-AKI was 10.2% (72 patients). In 94 (13.3%) patients serum creatinine decreased ≥25% either 24 or 48 hours after angiography. Patients with CI-AKI had a lower creatinine and a higher eGFR at baseline, but no other independent predictors of CI-AKI could be identified. Kidney function was not different between both groups one and three months after discharge. After a two year follow up the overall incidence of cardiovascular events was 56.5% in the CI-AKI group and 58.8% in the Non CI-AKI group (p = 0.8), the incidence of myocardial infarctions, however, was higher in CI-AKI-patients. Overall survival was also not different between patients with CI-AKI (88.6%) and without CI-AKI (84.7%, p = 0.48). The occurrence of CI-AKI did not have any negative impact on mid-term kidney function, the incidence of cardiovascular events and mortality. Considerable fluctuations of serum creatinine interfere with the presumed diagnosis of CI-AKI. Necessary angiographic procedures should not be withheld in fear of CI-AKI.
造影剂诱导的急性肾损伤（CI-AKI）的存在及其临床相关性仍存在很大争议，特别是在 CKD 患者中，由于担心发生 CI-AKI，常使血管造影术被延迟或被放弃。我们调查了接受动脉内血管造影术的心血管高危患者中 CI-AKI 的发生率及其对中期肾功能、心血管事件和死亡率的影响。我们对计划接受动脉内血管造影术的患者进行了前瞻性观察性试验。所有患者在应用造影剂前均接受标准化的静脉水化。根据造影后 24 小时或 48 小时内肌酐从基线升高≥25%定义 CI-AKI。在出院后 1 个月和 3 个月，从机构医疗记录系统中记录血肌酐和 eGFR。对患者进行了 2 年的随访，以研究 CI-AKI 对心血管事件和死亡率的长期影响。我们研究了 706 例（317 例女性）平均 eGFR 为 52.0±15ml·min·1·73·m2 的患者。CI-AKI 的发生率为 10.2%（72 例）。94 例（13.3%）患者在造影后 24 或 48 小时内血清肌酐降低≥25%。CI-AKI 患者的基线肌酐较低，eGFR 较高，但未发现其他与 CI-AKI 相关的独立预测因素。出院后 1 个月和 3 个月，两组患者的肾功能无差异。在 2 年的随访中，CI-AKI 组的总体心血管事件发生率为 56.5%，非 CI-AKI 组为 58.8%（p=0.8），但 CI-AKI 患者的心肌梗死发生率较高。CI-AKI 患者和非 CI-AKI 患者的总体生存率无差异（88.6% vs. 84.7%，p=0.48）。CI-AKI 的发生对中期肾功能、心血管事件和死亡率均无不良影响。血清肌酐的显著波动干扰了对 CI-AKI 的假定诊断。在担心发生 CI-AKI 的情况下，不应放弃必要的血管造影术。
