Cardiovascular Research Institute and Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, 110840, China.
Department of Cardiovascular, Anqing Municipal Hospital, Anqing, 246000, Anhui, China.
Mil Med Res. 2020 Mar 26;7(1):14. doi: 10.1186/s40779-020-00243-x.
None of study mentioned about contrast-induced acute kidney injury (CI-AKI) in people who have received contrast agents twice within in a short period of time. This study is trying to identify the predictors.
We enrolled 607 patients between Oct. 2010 and Jul. 2015 who received contrast agents twice within 30 days in the Department of Cardiology of the General Hospital of Shenyang Military Region. The primary outcome was CI-AKI within 72 h after contrast agent exposure. Patients were divided into groups A (n = 559) and group B (n = 48) according to whether CI-AKI occurred after the second agent.
Patients in group B (CI-AKI occurred after the second agent) had a more rapid heart rate and more usage of diuretics and digitalis. In group B, CI-AKI occurred more frequently after the first agent. Multivariate logistic regression showed that diuretic (P = 0.006) and intra-aortic balloon pump (IABP) usage (P = 0.012) were independent predictors of CI-AKI after the first agent. Angiotensin-converting enzyme inhibitor/Angiotensin II receptor antagonist (ACEI/ARB) usage (P = 0.039), IABP usage (P = 0.040) and CI-AKI occurring after administration of the first agent (P = 0.015) were independent predictors of CI-AKI after the second. Furthermore, dividing the patients into tertiles of the time interval between the two agents showed that CI-AKI occurred more frequently when the second agent was administered within 1-3 days after the first exposure than within 4-6 days (12.4% vs. 5.0%, P = 0.008) or ≥ 7 days (12.4% vs. 6.4%, P = 0.039).
Diuretic and IABP usage are independent predictors of CI-AKI following exposure to a first contrast agent. The major predictors of CI-AKI after exposure to a second agent are time since the first contrast exposure, ACEI/ARB usage, and IABP usage. More importantly, a three-day interval between the two agents is associated with a higher incidence of CI-AKI following the second administration.
目前还没有研究报道在短时间内两次使用造影剂的人群中会发生对比剂诱导的急性肾损伤（CI-AKI）。本研究旨在确定预测因素。
我们纳入了 2010 年 10 月至 2015 年 7 月在沈阳军区总医院心内科接受两次造影剂检查且两次检查时间间隔在 30 天内的 607 例患者。主要转归为造影剂暴露后 72 小时内发生 CI-AKI。根据第二次造影剂检查后是否发生 CI-AKI，将患者分为 A 组（n=559）和 B 组（n=48）。
B 组（第二次造影剂检查后发生 CI-AKI）患者的心率更快，利尿剂和洋地黄类药物的使用率更高。B 组患者在第一次造影剂检查后更常发生 CI-AKI。多变量 logistic 回归显示利尿剂（P=0.006）和主动脉内球囊反搏（IABP）的使用（P=0.012）是第一次造影剂检查后发生 CI-AKI 的独立预测因素。血管紧张素转换酶抑制剂/血管紧张素 II 受体拮抗剂（ACEI/ARB）的使用（P=0.039）、IABP 的使用（P=0.040）和第一次造影剂检查后发生 CI-AKI（P=0.015）是第二次造影剂检查后发生 CI-AKI 的独立预测因素。此外，将患者按两次造影剂之间的时间间隔分为三分位组，结果显示第二次造影剂检查在第一次造影剂检查后 1-3 天内进行时，CI-AKI 的发生率高于在 4-6 天（12.4%比 5.0%，P=0.008）或≥7 天（12.4%比 6.4%，P=0.039）时。
利尿剂和 IABP 的使用是第一次造影剂检查后发生 CI-AKI 的独立预测因素。第二次造影剂检查后发生 CI-AKI 的主要预测因素是第一次造影剂检查后时间、ACEI/ARB 的使用和 IABP 的使用。更重要的是，两次造影剂之间的 3 天间隔与第二次造影剂检查后 CI-AKI 的发生率增加有关。
