Medicine A Department, Charles Nicolle Hospital, Tunis, Tunisia.
Cardiology Department, Habib Thameur Hospital, Tunis, Tunisia.
Pan Afr Med J. 2023 Jul 26;45:144. doi: 10.11604/pamj.2023.45.144.30749. eCollection 2023.
vascular opacification using iodinated contrast media (ICM) is often the primary diagnostic and therapeutic approach. However, the risk of post-injection nephrotoxicity of ICM is significantly higher in patients with underlying nephropathy. This study aimed to determine the incidence of Contrast Media Induced Nephropathy (CMIN) and identify predictive factors for its occurrence in patients from a cardiology department.
our prospective study involved 158 patients who underwent coronary angiography or angioplasty at the cardiology department between December 2017 and May 2018. Two types of ICM were used in our study: Iopromide and Iohexol. All patients received either physiological serum (9‰) or bicarbonate serum (14‰) intravenously for hydration. We defined impaired renal function as an increase in creatinine ranging from 10 to 26 µmol/L, while CMIN was defined as an increase in serum creatinine exceeding 26.5 µmol/L. We investigated the factors associated with CMIN using logistic regression analysis.
the mean age of our patients was 60 ± 11 years (range: 29-82), with a predominance of men 63.9% (n=101). The most common cardiovascular risk factors were tobacco (36.1%, n = 57), diabetes (48.1%, n =76), hypertension (55%, n = 87). Pre-procedural creatinine averaged 81.1 ± 47.3 µmol / L with extremes ranging from 39 to 600 µmol / L. The median Mehran risk score was 3.2 (range: 0- 15). The interventional cardiology act consisted of coronary angiography in 86.2% (n=136) of cases, coronary angioplasty in 2.5% (n=4) of cases. We used iohexol and iopromide in 57.6% (n=91) and 42.4% (n=67) of cases, respectively. The overall incidence of CMIN was 9.5% (n=9). The multivariable regression analysis identified 4 risk factors independently linked to the occurrence of CMIN which were Pre-existing renal failure (OR: 6.05, 95%CI [1.23-29.62], p = 0.026), anemia (OR: 0.043, CI [1.03-8.96], p = 0.043), the toxic dose of PC (OR: 4.7, CI [1.28-17.7], p=0.02), and at a Mehran score = 11 (OR: 3.7, CI [0.88-15.6], p=0.036).
the most effective approach for CMIN is prevention, which focuses on addressing modifiable risk factors to minimize the risk especially in patients with pre-existing renal failure.
使用含碘对比剂（ICM）进行血管造影通常是主要的诊断和治疗方法。然而，在有基础肾病的患者中，ICM 注射后肾毒性的风险显著增加。本研究旨在确定心内科患者中对比剂诱导肾病（CMIN）的发生率，并确定其发生的预测因素。
我们的前瞻性研究纳入了 2017 年 12 月至 2018 年 5 月在心脏病科接受冠状动脉造影或血管成形术的 158 名患者。我们的研究中使用了两种类型的 ICM：碘普罗胺和碘海醇。所有患者均接受生理血清（9‰）或碳酸氢盐血清（14‰）静脉补液。我们将肾功能受损定义为肌酐升高 10-26µmol/L，而 CMIN 则定义为血清肌酐升高超过 26.5µmol/L。我们使用逻辑回归分析调查与 CMIN 相关的因素。
我们患者的平均年龄为 60±11 岁（范围：29-82），男性占 63.9%（n=101）。最常见的心血管危险因素是吸烟（36.1%，n=57）、糖尿病（48.1%，n=76）、高血压（55%，n=87）。术前肌酐平均为 81.1±47.3µmol/L，范围为 39-600µmol/L。Mehran 风险评分中位数为 3.2（范围：0-15）。介入心脏病学操作包括冠状动脉造影 86.2%（n=136），冠状动脉成形术 2.5%（n=4）。碘海醇和碘普罗胺分别用于 57.6%（n=91）和 42.4%（n=67）的患者。CMIN 的总发生率为 9.5%（n=9）。多变量回归分析确定了 4 个与 CMIN 发生相关的独立风险因素，分别是：先前存在的肾衰竭（OR：6.05，95%CI [1.23-29.62]，p=0.026）、贫血（OR：0.043，CI [1.03-8.96]，p=0.043）、PC 毒性剂量（OR：4.7，CI [1.28-17.7]，p=0.02）和 Mehran 评分=11（OR：3.7，CI [0.88-15.6]，p=0.036）。
CMIN 的最有效方法是预防，重点是解决可改变的危险因素，以尽量降低风险，特别是在有基础肾衰竭的患者中。
