Department of Medicine D, Rambam Health Care Campus and Ruth & Bruce Rappaport Faculty of Medicine, Technion-IIT, Haifa, Israel.
Department of Medicine, Hadassah Hebrew University Hospital, Mt. Scopus, Jerusalem, Israel.
Am J Nephrol. 2021;52(1):76-83. doi: 10.1159/000513914. Epub 2021 Mar 3.
Large data analyses confirm the relative safety of contrast-enhanced computed tomography (CT), except for those with advanced renal failure. However, the prevalence of post-contrast acute kidney injury may be masked by acute kidney functional recovery (AKR) in unstable inpatients, irrespective of contrast-enhanced imaging.
In this work we aimed to assess AKI and AKR along with need for dialysis and mortality, among inpatients undergoing contrast-enhanced or non-enhanced CT. We performed a large-scale retrospective data analysis using propensity score matching (PSM) that compared patients undergoing contrast-enhanced and non-enhanced imaging. We also performed a subgroup analysis of subjects stratified by baseline renal function.
A total of 41,456 patients were analyzed. PSM resulted in well-balanced groups. AKR occurred substantially more often than AKI among hospitalized patients following CT imaging, especially among those with low baseline renal function. Yet, in this population, whereas the rate of AKI significantly increased, the rate of AKR significantly decreased following contrast-enhanced studies as compared to patients that underwent non-enhanced CT. A significantly higher proportion of patients with baseline advanced renal failure that underwent contrast-enhanced imaging required dialysis.
The increased incidence of AKI and AKR as seen in patients with lower pre-imaging kidney function possibly suggests that both entities reflect impaired renal functional reserve. Unstable kidney function in inpatients, as demonstrated by rates of AKR and AKI, is an important confounder which requires attention in similar observational studies on the renal effects of contrast media and of various other renal injurious events.
大型数据分析证实，除了晚期肾功能衰竭患者外，对比增强计算机断层扫描（CT）相对安全。然而，对比增强成像可能会掩盖不稳定住院患者的急性肾损伤后急性肾功能恢复（AKR），无论是否进行对比增强成像。
在这项工作中，我们旨在评估接受对比增强或非增强 CT 的住院患者的急性肾损伤和 AKR 以及透析和死亡率。我们使用倾向评分匹配（PSM）进行了大规模回顾性数据分析，比较了接受对比增强和非增强成像的患者。我们还对按基线肾功能分层的患者进行了亚组分析。
共分析了 41456 名患者。PSM 产生了均衡的组。CT 成像后，住院患者中 AKR 的发生率明显高于 AKI，尤其是基线肾功能较低的患者。然而，在该人群中，与接受非增强 CT 的患者相比，接受对比增强研究的患者 AKI 的发生率显著增加，而 AKR 的发生率显著降低。基线肾功能衰竭严重的患者中，接受对比增强成像的患者需要透析的比例明显更高。
在基线肾功能较低的患者中，AKI 和 AKR 的发生率增加，这可能表明这两种情况都反映了肾功能储备受损。不稳定的住院患者的肾功能，如 AKR 和 AKI 的发生率所示，是一个重要的混杂因素，在观察性研究中需要注意对比剂和其他各种肾损伤事件对肾功能的影响。
