Department of Endocrinology and Metabolism, Diabetic Foot Care Center, West China Hospital, Sichuan University, Chengdu, China.
Department of Endocrinology and Metabolism, West China Longquan Hospital Sichuan University, and The First People's Hospital of Longquanyi District, Chengdu, China.
Front Endocrinol (Lausanne). 2023 Jan 12;13:1042312. doi: 10.3389/fendo.2022.1042312. eCollection 2022.
According to previous studies, the incidence of post-contrast acute kidney injury(PC-AKI) in diabetic is far higher than that in the general population. Therefore, we explored the relationship between the incidence of PC-AKI and different baseline serum creatinine (SCr) levels, and determined the relationship between PC-AKI and different types of contrast media (CMs), different doses of CM, and different examination methods in this specific population.
Patients with diabetes in whom CM was used between 2010 and 2020 at our institution were included. Participants were identified according to the following three schemes: Scheme 1 (n=5911), SCr was detected before and within 72 h after using CM; Scheme 2 (n=2385), SCr was detected within 24 h before and within 24-72 h after using CM; and Scheme 3 (n=81), SCr was detected within 24 h before and within 0-24, 24-48, and 48-72 h after using CM. The incidence of PC-AKI with different types of CM, incidence of PC-AKI on digital subtraction angiography (DSA) and enhanced computed tomography (CT), proportion of PC-AKI with different doses of CM, and baseline SCr at different stages of PC-AKI were compared. Multivariate logistic regression analysis was used to explore risk factors for PC-AKI.
A total of 29,081 patients were included in this study. The incidence of PC-AKI in Scheme 3 (22.22%) was higher than those in Schemes 1 (6.19%) and 2 (7.71%). The incidence of PC-AKI on DSA was higher than that on enhanced CT (8.30% vs. 5.80%; <0.05). The incidence of PC-AKI in the increased-dose CM group was higher than that in the non-increased-dose CM group (7.9% vs. 5.7%; <0.01). Moreover, there were differences in baseline SCr values at different stages of PC-AKI (<0.01). Multivariate logistic regression analysis showed that hypertension, chronic kidney disease, heart failure, peripheral vascular disease, metformin, diuretics, and CM dose were risk factors for PC-AKI.
The incidence of PC-AKI increased significantly with increasing time requirement and frequency of SCr detection. Moreover, before using CM, we should control the blood pressure and heart failure, stop using metformin and diuretics, and use CMs at the minimum dose to avoid PC-AKI.
根据以往的研究，糖尿病患者发生造影剂后急性肾损伤（PC-AKI）的发生率远高于普通人群。因此，本研究旨在探讨不同基线血清肌酐（SCr）水平与 PC-AKI 发生率的关系，并确定在该特定人群中，PC-AKI 与不同类型的对比剂（CM）、不同剂量的 CM 和不同的检查方法之间的关系。
纳入了 2010 年至 2020 年在我院使用 CM 的糖尿病患者。根据以下三种方案识别参与者：方案 1（n=5911），在使用 CM 前后 72 小时内检测 SCr；方案 2（n=2385），在使用 CM 前后 24 小时内检测 SCr；方案 3（n=81），在使用 CM 前后 24 小时内检测 SCr，并在使用 CM 后 0-24、24-48 和 48-72 小时内检测 SCr。比较不同类型 CM 的 PC-AKI 发生率、数字减影血管造影（DSA）和增强计算机断层扫描（CT）的 PC-AKI 发生率、不同剂量 CM 的 PC-AKI 发生率以及 PC-AKI 不同阶段的基线 SCr。采用多变量 logistic 回归分析探讨 PC-AKI 的危险因素。
本研究共纳入 29081 例患者。方案 3（22.22%）的 PC-AKI 发生率高于方案 1（6.19%）和方案 2（7.71%）。DSA 的 PC-AKI 发生率高于增强 CT（8.30%比 5.80%；<0.05）。增加剂量 CM 组的 PC-AKI 发生率高于非增加剂量 CM 组（7.9%比 5.7%；<0.01）。此外，PC-AKI 不同阶段的基线 SCr 值存在差异（<0.01）。多变量 logistic 回归分析显示，高血压、慢性肾脏病、心力衰竭、外周血管疾病、二甲双胍、利尿剂和 CM 剂量是 PC-AKI 的危险因素。
随着 SCr 检测时间要求和频率的增加，PC-AKI 的发生率显著增加。此外，在使用 CM 之前，我们应该控制血压和心力衰竭，停止使用二甲双胍和利尿剂，并使用最低剂量的 CM，以避免 PC-AKI。
