高危患者中的对比剂肾病：是神话还是现实？

Contrast Induced Nephropathy In High Risk Patients - Myth Or Reality.

机构信息

KRL Hospital Islamabad, Pakistan.

出版信息

J Ayub Med Coll Abbottabad. 2021 Oct-Dec;33(4):568-571.

Abstract

BACKGROUND

Contrast induced nephropathy (CIN) is a potential stumbling block in administration of contrast media. CIN has been defined as an elevation of serum creatinine (sCr) of more than ≥0.5 mg/dl (44 μmol/l) or 25% from the baseline within 48-72 hours in the truancy of alternate tenets of acute kidney injury. Incidence of CI-AKI in patients undergoing coronary angiography with normal baseline renal function was reported to be <3%. However, the occurrence of CI-AKI was found to be as high as 50% in CKD patients undergoing Coronary Angiography. This high incidence reported by different studies is mainly because of the difference in definition, underlying renal failure, type and dose of contrast media used and frequency of other co-existing important causes of acute kidney injury (AKI). Recent studies have been published showing that risk of CIN is an overestimated and over-reckoned entity in literature. Objective: To determine the frequency of CIN in CKD patients with Creatinine clearance (Crcl) less than 60 ml/min undergoing contrast exposure.

METHODS

We conducted Prospective, controlled single center trial in 42 patients having the creatinine clearance of less than 60 ml/min, they were risk stratified according to Mehran scoring system and underwent coronary angiography or contrast enhanced CT scan with contrast and specific protocol for prevention of CIN including intra-venous (IV) hydration with 0.9% Normal Saline was given before the procedure and were followed up to initial 72 hours post procedure.

RESULTS

33 out of 42 patients, i.e., got adequate hydration as per protocol however 11 patients underwent procedure as pre-existing condition did not allow so. Out of 42 patients, risk stratification according to Mehran Scoring system revealed that 15 patients out of 42 patients were included in very high risk group, 14 were in high risk group and 13 patients were in intermediate risk group. Our experience revealed that 5 out of 42 patients (11.3%) were those who experienced CI-AKI and interestingly none of them required haemodialysis.

CONCLUSIONS

Our study has raised serious question on incidence of CIN in high risk patients as reported previously. However, more studies are needed over this issue till that time we might consider CIN A myth rather than a reality.

摘要

背景

对比剂肾病（CIN）是使用对比剂时潜在的障碍。CIN 的定义为在急性肾损伤的其他原则出现后 48-72 小时内，血清肌酐（sCr）升高≥0.5mg/dl（44μmol/l）或基线值的 25%。在肾功能正常的患者中，行冠状动脉造影术的患者中 CI-AKI 的发生率<3%。然而，在接受冠状动脉造影术的 CKD 患者中，CI-AKI 的发生率高达 50%。不同研究报告的高发生率主要是因为定义、潜在的肾功能衰竭、使用的对比剂类型和剂量以及急性肾损伤（AKI）的其他共同重要原因的频率不同。最近的研究表明，CIN 的风险是文献中被高估和夸大的实体。目的：确定 Crcl 小于 60ml/min 的 CKD 患者在接受对比剂暴露时 CIN 的频率。

方法

我们对 42 例 Crcl 小于 60ml/min 的患者进行了前瞻性、对照性单中心试验，根据 Mehran 评分系统对患者进行风险分层，并进行冠状动脉造影或对比增强 CT 扫描，并使用对比剂，以及预防 CIN 的特定方案，包括在术前给予 0.9%生理盐水静脉输液，并在术后最初 72 小时内进行随访。

结果

42 例患者中，33 例按方案充分水化，但 11 例因术前存在的情况不允许而进行了该程序。根据 Mehran 评分系统进行风险分层，42 例患者中，15 例患者被归入极高危组，14 例患者为高危组，13 例患者为中危组。我们的经验表明，42 例患者中有 5 例（11.3%）出现 CI-AKI，有趣的是，他们中没有一人需要血液透析。