Department of Emergency Medicine, Ajou University School of Medicine, Suwon, South Korea.
Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, South Korea.
Med Sci Monit. 2020 Mar 23;26:e921303. doi: 10.12659/MSM.921303.
BACKGROUND There are many studies on acute kidney injury (AKI) after exposure to contrast media in patients with chronic kidney disease (CKD). However, whether the risk of end-stage renal disease (ESRD) increases after exposure to contrast media in the long term, regardless of development of AKI after such exposure, has not been studied. MATERIAL AND METHODS The electronic health records of patients diagnosed with CKD and followed up from 2014 to 2018 at a tertiary university hospital were retrospectively collected. Patients were divided into patients who progressed to ESRD (ESRD group) and those who did not (non-ESRD group). Patients in the non-ESRD group were matched 1: 1 to those in the ESRD group by using disease risk score generation and matching. Multivariate logistic regression analysis was performed to assess the effect of contrast media exposure on progression to ESRD. RESULTS In total, 179 patients were enrolled per group; 178 (99.4%) were in CKD stage 3 or above in both groups. Average serum creatinine was 4.31±3.02 mg/dl and 3.64±2.55 mg/dl in the ESRD and non-ESRD groups, respectively (p=0.242). Other baseline characteristics were not statistically significant, except for the number of times contrast-enhanced computed tomography (CECT) was performed (0.00 [Interquartile range (IQR) 0.00-2.00] in the ESRD group and 0.00 [IQR 0.00-1.00] in the non-ESRD group [p=0.006]); in multivariate logistic regression, this number (OR=1.24, 95% CI=1.08-1.47, p=0.006) was significantly related to progression to ESRD. CONCLUSIONS The use of CECT increased the risk of ESRD 1.2-fold in advanced and stable CKD outpatients after 5-year follow-up.
有许多关于慢性肾脏病(CKD)患者接触造影剂后发生急性肾损伤(AKI)的研究。然而,无论接触造影剂后是否发生 AKI,长期接触造影剂后是否会增加终末期肾病(ESRD)的风险尚未得到研究。
回顾性收集了 2014 年至 2018 年在一家三级大学医院就诊并随访的 CKD 患者的电子健康记录。将患者分为进展为 ESRD(ESRD 组)和未进展为 ESRD(非 ESRD 组)。非 ESRD 组的患者通过疾病风险评分生成和匹配与 ESRD 组按 1:1 配对。采用多变量逻辑回归分析评估造影剂暴露对进展为 ESRD 的影响。
每组纳入 179 例患者;两组均有 178 例(99.4%)患者处于 CKD 3 期或以上。ESRD 组和非 ESRD 组的平均血清肌酐分别为 4.31±3.02mg/dl 和 3.64±2.55mg/dl(p=0.242)。其他基线特征无统计学意义,除增强 CT 扫描次数(ESRD 组 0.00[IQR 0.00-2.00],非 ESRD 组 0.00[IQR 0.00-1.00],p=0.006)外;在多变量逻辑回归中,该次数(OR=1.24,95%CI=1.08-1.47,p=0.006)与进展为 ESRD 显著相关。
在 5 年随访后,在稳定的晚期 CKD 门诊患者中,使用 CECT 会使 ESRD 的风险增加 1.2 倍。