Faruqi Imran, Caffery Terrell, Colter Maddie, Williams Cameron, Trent Ashley, Cushner Douglas, Nelson Jacob, Davis Greggory
Louisiana State University Health Sciences Center School of Medicine - New Orleans, Baton Rouge Branch Campus, Baton Rouge, Louisiana.
Louisiana State University Health Sciences Center School of Medicine - New Orleans, Baton Rouge Branch Campus, Baton Rouge, Louisiana; Our Lady of the Lake Regional Medical Center, Baton Rouge, Louisiana.
J Emerg Med. 2025 Mar;70:10-18. doi: 10.1016/j.jemermed.2024.09.012. Epub 2024 Oct 10.
Chronic kidney disease (CKD) is to be considered an independent risk factor for developing post-computed tomography (CT) acute kidney injury (AKI); however, current data are limited.
Examine the incidence of AKI after intravenous contrast exposure among patients with and without CKD.
A single-center retrospective study examined patients that presented to the Emergency Department and activated the stroke protocol, which involved an immediate CT angiogram. Patients were subdivided into "normal to mild" (glomerular filtration rate [GFR] > 60 mL/min/1.73 m), CKD III (GFR 30-60 mL/min/1.73 m), and CKD IV (GFR < 30 mL/min/1.73 m) groups. The primary outcome was the development of AKI. Patients already on dialysis were excluded.
Among the 794 patients identified, 452 (56.9%) were classified as "normal to mild," 280 (35.3%) were classified as CKD III, and 62 (7.8%) were classified as CKD IV. Patients with normal GFR had a 2.4% incidence of developing AKI, those with CKD III had a 1.4% incidence, and patients with CKD IV had an 8.1% incidence of developing AKI. Overall, 2.5% of patients developed AKI. For CKD III vs. "normal" groups, odds ratio (OR) = 0.58 (95% confidence interval [CI] 0.16-1.72). For CKD IV vs. "normal," OR = 3.52 (95% CI 1.07-10.05). Of those patients with CKD IV who had AKI, all saw improvement in their creatinine prior to discharge and none required renal replacement therapy.
This study builds on the evidence demonstrating that patients with CKD III are likely at the same risk of developing post-CT AKI as those with normal renal function. Furthermore, the risk of developing post-CT AKI in CKD IV patients may be far lower than previously thought, was transient, and did not result in renal replacement therapy.
慢性肾脏病（CKD）被认为是计算机断层扫描（CT）后发生急性肾损伤（AKI）的一个独立危险因素；然而，目前的数据有限。
研究有无CKD的患者静脉注射造影剂后发生AKI的发生率。
一项单中心回顾性研究对就诊于急诊科并启动卒中方案（包括立即进行CT血管造影）的患者进行了检查。患者被分为“正常至轻度”（肾小球滤过率[GFR]>60 mL/min/1.73 m²）、CKD Ⅲ期（GFR 30 - 60 mL/min/1.73 m²）和CKD Ⅳ期（GFR<30 mL/min/1.73 m²）组。主要结局是发生AKI。已接受透析的患者被排除。
在纳入的794例患者中，452例（56.9%）被分类为“正常至轻度”，280例（35.3%）被分类为CKD Ⅲ期，62例（7.8%）被分类为CKD Ⅳ期。GFR正常的患者发生AKI的发生率为2.4%，CKD Ⅲ期患者为1.4%，CKD Ⅳ期患者发生AKI的发生率为8.1%。总体而言，2.5%的患者发生了AKI。CKD Ⅲ期与“正常”组相比，比值比（OR）=0.58（95%置信区间[CI]0.16 - 1.72）。CKD Ⅳ期与“正常”组相比，OR = 3.52（95%CI 1.07 - 10.05）。在发生AKI的CKD Ⅳ期患者中，所有患者出院前肌酐均有所改善，且无一例需要肾脏替代治疗。
本研究进一步证明了CKD Ⅲ期患者发生CT后AKI的风险可能与肾功能正常者相同。此外，CKD Ⅳ期患者发生CT后AKI的风险可能远低于先前认为的水平，是短暂的，且未导致肾脏替代治疗。
