Wu Ming-Ju, Tsai Shang-Feng
Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 407, Taiwan.
School of Medicine, Chung Shan Medical University, Taichung 402, Taiwan.
Diagnostics (Basel). 2022 Mar 30;12(4):864. doi: 10.3390/diagnostics12040864.
Introduction: Iodinated contrast medium (CM) is the third most common cause of acute kidney injury (AKI). However, the association is poorly known between the definitions of AKI between different stages of chronic kidney disease after intravenous CM administration. Methods: The dataset, covering a period of ~15 years (1 June 2008 to 31 March 2015), consisted of 20,018 non-dialytic adult patients who had received intravenous injections of non-ionic iso-osmolar CM, iodixanol, for enhanced computed tomography imaging. Contrast-associated AKI (CA-AKI), dialysis-required AKI, and mortality were analyzed. Results: A total of 12,271 participants were enrolled. CA-AKI increased significantly starting from stage 3A onward (p < 0.001). In summary, incidences of CA-AKI against different levels of chronic kidney disease were as follows: stage 1 (8.3%) = stage 2 (6.7%) < stage 3A (9.9%) < stage 3B (14.3%) < stage 4 (20.5%) = stage 5 (20.4%). The incidences of dialysis within 30 days were as follows: stage 1 (1%) = stage 2 (1.4%) = stage 3A (2.7%) < stage 3B (5.7%) < stage 4 (18%) < stage 5 (54.1%). The prediction of dialysis was good based on the baseline serum creatinine > 1.5 mg/dL (72.78% of sensitivity, 86.07% of specificity, 0.851 of area under curve) or baseline estimated glomerular filtration rate ≤ 38.49 mL/min/1.732 m2 (70.19% of sensitivity, 89.08% of specificity, 0.853 of area under curve). In multivariate Cox regression analysis model for CA-AKI, independent risk factors were stage 4 chronic kidney disease (p = 0.001) and shock (p = 0.001). Conclusion: Baseline serum creatinine and estimated glomerular filtration rate were good predictors for dialysis-required AKI. CA-AKI increased significantly since stage 3A chronic kidney disease. Stage 4 and 5 chronic kidney disease have the same risk for CA-AKI, but stage 5 chronic kidney disease has markedly higher risk for dialysis.
碘化造影剂（CM）是急性肾损伤（AKI）的第三大常见病因。然而，静脉注射CM后，不同阶段慢性肾脏病（CKD）中AKI定义之间的关联鲜为人知。方法：数据集涵盖约15年（2008年6月1日至2015年3月31日），由20018例接受非离子等渗CM碘克沙醇静脉注射以进行增强计算机断层扫描成像的非透析成年患者组成。分析了造影剂相关AKI（CA-AKI）、需要透析的AKI及死亡率。结果：共纳入12271名参与者。从3A期起，CA-AKI显著增加（p<0.001）。总之，不同慢性肾脏病水平的CA-AKI发生率如下：1期（8.3%）=2期（6.7%）<3A期（9.9%）<3B期（14.3%）<4期（20.5%）=5期（20.4%）。30天内透析发生率如下：1期（1%）=2期（1.4%）=3A期（2.7%）<3B期（5.7%）<4期（18%）<5期（54.1%）。基于基线血清肌酐>1.5mg/dL（敏感性72.78%，特异性86.07%，曲线下面积0.851）或基线估计肾小球滤过率≤38.49mL/min/1.732m²（敏感性70.19%，特异性89.08%，曲线下面积0.853）对透析的预测良好。在CA-AKI的多因素Cox回归分析模型中，独立危险因素为4期慢性肾脏病（p=0.001）和休克（p=0.001）。结论：基线血清肌酐和估计肾小球滤过率是需要透析的AKI的良好预测指标。自3A期慢性肾脏病起，CA-AKI显著增加。4期和5期慢性肾脏病发生CA-AKI的风险相同，但5期慢性肾脏病透析风险明显更高。
