Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Department of Radiology, Sahlgrenska University Hospital, Bruna Stråket 11B, 41345, Gothenburg, Sweden.
Eur Radiol. 2021 May;31(5):3248-3257. doi: 10.1007/s00330-020-07429-w. Epub 2020 Nov 6.
Previous large studies of contrast-induced or post-contrast acute kidney injury (CI-AKI/PC-AKI) have been observational, and mostly retrospective, often with patients undergoing non-enhanced CT as controls. This carries risk of inclusion bias that makes the true incidence of PC-AKI hard to interpret. Our aim was to determine the incidence of PC-AKI in a large, randomly selected cohort, comparing the serum creatinine (Scr) changes after contrast medium exposure with the normal intraindividual fluctuation in Scr.
In this prospective study of 1009 participants (age 50-65 years, 48% females) in the Swedish CArdioPulmonary bioImage Study (SCAPIS), with estimated glomerular filtration rate (eGFR) ≥ 50 mL/min, all received standard dose intravenous iohexol at coronary CT angiography (CCTA). Two separate pre-CCTA Scr samples and a follow-up sample 2-4 days post-CCTA were obtained. Change in Scr was statistically analyzed and stratification was used in the search of possible risk factors.
Median increase of Scr post-CCTA was 0-2 μmol/L. PC-AKI was observed in 12/1009 individuals (1.2%) according to the old ESUR criteria (> 25% or > 44 μmol/L Scr increase) and 2 individuals (0.2%) when using the updated ESUR criteria (≥ 50% or ≥ 27 μmol/L Scr increase). Possible risk factors (e.g., diabetes, age, eGFR, NSAID use) did not show increased risk of developing PC-AKI. The mean effect of contrast media on Scr did not exceed the intraindividual Scr fluctuation.
Iohexol administration to a randomly selected cohort with mildly reduced eGFR is safe, and PC-AKI is very rare, occurring in only 0.2% when applying the updated ESUR criteria.
• Iohexol administration to a randomly selected cohort, 50-65 years old with mildly reduced eGFR, is safe and PC-AKI is very rare. • Applying the updated ESUR PC-AKI criteria resulted in fewer cases, 0.2% compared to 1.2% using the old ESUR criteria in this cohort with predominantly mild reduction of renal function. • The mean effect of CM on Scr did not exceed the intraindividual background fluctuation of Scr, regardless of potential risk factors, such as diabetes or NSAID use in our cohort of 1009 individuals.
先前关于对比剂诱导或对比后急性肾损伤（CI-AKI/PC-AKI）的大型研究都是观察性的，且大多为回顾性的，常以接受非增强 CT 作为对照的患者进行研究。这存在纳入偏倚的风险，使得 PC-AKI 的真实发生率难以解释。我们的目的是在一个大型随机选择的队列中确定 PC-AKI 的发生率，比较造影剂暴露后血清肌酐（Scr）的变化与 Scr 个体内正常波动。
在瑞典心肺生物影像研究（SCAPIS）的 1009 名参与者（年龄 50-65 岁，48%为女性）的这项前瞻性研究中，所有参与者的估算肾小球滤过率（eGFR）≥50 mL/min，均在冠状动脉 CT 血管造影（CCTA）时接受标准剂量的静脉注射碘海醇。在 CCTA 前分别采集两次单独的 Scr 样本和 CCTA 后 2-4 天的随访样本。对 Scr 的变化进行统计学分析，并进行分层以寻找可能的危险因素。
根据旧的 ESUR 标准（>25%或>44 μmol/L Scr 升高），1009 例患者中有 12 例（1.2%）发生 PC-AKI，根据更新的 ESUR 标准（≥50%或≥27 μmol/L Scr 升高），有 2 例（0.2%）发生 PC-AKI。可能的危险因素（如糖尿病、年龄、eGFR、非甾体抗炎药使用）并未显示出发生 PC-AKI 的风险增加。造影剂对 Scr 的平均影响并未超过个体内 Scr 的波动。
对于随机选择的 eGFR 轻度降低的患者，给予碘海醇是安全的，且 PC-AKI 非常罕见，仅在应用更新的 ESUR 标准时发生 0.2%。
对于随机选择的 eGFR 轻度降低的、年龄在 50-65 岁的患者，给予碘海醇是安全的，且 PC-AKI 非常罕见。
在本研究中，该队列的肾功能主要为轻度下降，应用更新的 ESUR PC-AKI 标准的病例数较少，为 0.2%，而应用旧的 ESUR 标准为 1.2%。
在我们的 1009 例患者队列中，无论是否存在糖尿病或 NSAID 使用等潜在危险因素，造影剂对 Scr 的平均影响均未超过 Scr 个体内背景波动。
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