From the Department of Internal Medicine D, Rambam Health Care Campus and Ruth & Bruce Rappaport Faculty of Medicine, Technion-IIT, Haifa.
Department of Medicine, Hadassah Hebrew University Hospital, Mt. Scopus, Jerusalem, Israel.
Invest Radiol. 2020 Oct;55(10):677-687. doi: 10.1097/RLI.0000000000000659.
The overall risk of postcontrast acute kidney injury (PC-AKI) after computerized tomography (CT) is negligible, likely because of the small volume of injected iodinated contrast media required. However, the safety of contrast media-enhanced CT in patients with advanced renal functional impairment, an established major risk factor for PC-AKI, is unknown.
This is a retrospective study using large data analysis of hospitalized patients at a single center. Adults undergoing CT or magnetic resonance imaging were included in the study and were stratified by estimated glomerular filtration rate (eGFR) (≤30 or >30 mL/min/1.73 m) and by either contrast-enhanced or nonenhanced imaging. Only patients with serial determination of creatinine before and after imaging were included. Demographic, clinical, and laboratory data between groups were analyzed and compared using univariate analysis, propensity score matching, and multivariate logistic regression analysis.
A total of 22,319 imaging studies were included. Patients with an eGFR of 30 mL/min/1.73 m or lower undergoing contrast-enhanced CT (n = 403) had an increased risk to develop PC-AKI than did similar patients undergoing enhanced or nonenhanced magnetic resonance imaging (n = 96) or nonenhanced CT (n = 1576) or patients undergoing contrast-enhanced CT with a preprocedural eGFR higher than 30 mL/min/1.73 m (n = 9173). These findings remained robust after propensity matching for demographic, procedural, and clinical parameters. Multivariate regression analysis of all patients undergoing CT with preimaging eGFR of 30 mL/min or lower (n = 1979) revealed that iodine-based contrast enhancement increased the likelihood of post-CT AKI by 51% (confidence interval, 1.23-2.05).
Although radiocontrast-enhanced CT is considered safe in most hospitalized patients and in ambulatory settings, the risk of PC-AKI remains significant among inpatients with substantial preimaging renal functional impairment. Caution is warranted using iodine-based enhanced CT in hospitalized patients with an eGFR of 30 mL/min/1.73 m or lower.
计算机断层扫描（CT）后对比剂急性肾损伤（PC-AKI）的总体风险可以忽略不计，这可能是因为所需的碘造影剂注射量很小。然而，对于肾功能严重受损的患者（PC-AKI 的一个主要危险因素），增强 CT 对比剂的安全性尚不清楚。
这是一项单中心回顾性研究，利用大型数据分析了住院患者。纳入研究的患者为接受 CT 或磁共振成像的成年人，并按估算肾小球滤过率（eGFR）（≤30 或＞30 ml/min/1.73 m）和增强或非增强成像进行分层。仅纳入有影像学前后连续肌酐检测的患者。采用单因素分析、倾向评分匹配和多因素逻辑回归分析比较组间的人口统计学、临床和实验室数据。
共纳入 22319 项影像学检查。eGFR 为 30 ml/min/1.73 m 或更低的患者行增强 CT 检查（n=403）发生 PC-AKI 的风险高于行增强或非增强磁共振成像（n=96）或非增强 CT（n=1576）或行增强 CT 且术前 eGFR 高于 30 ml/min/1.73 m（n=9173）的相似患者。在对人口统计学、程序和临床参数进行倾向评分匹配后，这些发现仍然具有稳健性。对所有行 CT 检查且 eGFR 低于 30 ml/min 的患者（n=1979）进行多变量回归分析显示，碘造影剂增强使 CT 后 AKI 的可能性增加了 51%（置信区间，1.23-2.05）。
尽管放射性对比增强 CT 在大多数住院患者和门诊环境中被认为是安全的，但在肾功能严重受损的住院患者中，PC-AKI 的风险仍然显著。对于 eGFR 为 30 ml/min/1.73 m 或更低的住院患者，使用碘基增强 CT 时应谨慎。
