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Контраст-индуцированное острое повреждение почек при проведении компьютерной томографии с внутривенным введением контрастного препарата у пациентов с сердечно-сосудистыми заболеваниями
Контраст-индуцированное острое повреждение почек при проведении компьютерной томографии с внутривенным введением контрастного препарата у пациентов с сердечно-сосудистыми заболеваниями
Васин А.А., Миронова О.Ю., Фомин В.В. Контраст-индуцированное острое повреждение почек при проведении компьютерной томографии с внутривенным введением контрастного препарата у пациентов с сердечно-сосудистыми заболеваниями. Consilium Medicum. 2021;23(12):928–930.
DOI: 10.26442/20751753.2021.12.201162
DOI: 10.26442/20751753.2021.12.201162
DOI: 10.26442/20751753.2021.12.201162
________________________________________________
DOI: 10.26442/20751753.2021.12.201162
Материалы доступны только для специалистов сферы здравоохранения. Авторизуйтесь или зарегистрируйтесь.
Аннотация
Цель. Оценка частоты развития контраст-индуцированного острого повреждения почек (КИ-ОПП) у пациентов с сердечно-сосудистыми заболеваниями (ССЗ), имеющих показания к проведению компьютерной томографии (КТ) с внутривенным контрастированием.
Материалы и методы. В проспективное наблюдательное исследование (clinicaltrials.gov №NCT04666389) включили 51 пациента с ССЗ с показаниями к проведению КТ с внутривенным контрастированием. У всех больных оценивалась скорость клубочковой фильтрации до исследования и через 48–72 ч. Первичной конечной точкой считалось развитие КИ-ОПП, определяемое в соответствии с критериями KDIGO. Женщины составили 51% пациентов, средний возраст – 61,74±1,5 года. Наиболее частым ССЗ являлась гипертоническая болезнь как у мужчин, так и у женщин – 52 и 39% соответственно.
Результаты. Развитие КИ-ОПП отмечалось у 2 (3,92%) больных. При этом статистически значимых взаимосвязей (р<0,05) между факторами риска и развитием данного осложнения установить не удалось.
Заключение. ССЗ могут повышать риск развития КИ-ОПП при проведении КТ с внутривенным контрастированием, в связи с чем рекомендуется оценивать концентрацию сывороточного креатинина у таких пациентов. Необходимы дальнейшие наблюдения для полноценной оценки риска развития КИ-ОПП.
Ключевые слова: контраст-индуцированное острое повреждение почек, контраст-индуцированная нефропатия, контраст-ассоциированное острое повреждение почек, компьютерная томография, контрастное вещество, сердечно-сосудистые заболевания, прогноз
Materials and methods. In prospective observational study (ClinicalTrials.gov ID NCT04666389) were included 51 patients with CVD undergoing CT with intravenous contrast media administration. The primary endpoint was CI-AKI according to KDIGO criteria [the 25% rise (or 0.5 mg/dl) of serum creatinine from baseline assessed 48–72 hours after administration of contrast media]. There were 51% of women included in the study. The average age was 61.74±1.5. The most frequent cardiovascular disease was hypertension in both men and women – 52 and 39% respectively.
Results. CI-AKI was diagnosed in 2 (3.92%) patients. At the same time, it was not possible to establish statistically significant relationship (p<0.05) between risk factors and the development of CI-AKI.
Conclusion. Cardiovascular diseases may increase the risk of CI-AKI after CT with intravenous contrast media administration. Therefore, it is recommended to evaluate the serum creatinine concentration in such patients.
Keywords: contrast-induced acute kidney injury, contrast-induced nephropathy, contrast-associated acute kidney injury, computed tomography, contrast media, cardiovascular diseases, prognosis
Материалы и методы. В проспективное наблюдательное исследование (clinicaltrials.gov №NCT04666389) включили 51 пациента с ССЗ с показаниями к проведению КТ с внутривенным контрастированием. У всех больных оценивалась скорость клубочковой фильтрации до исследования и через 48–72 ч. Первичной конечной точкой считалось развитие КИ-ОПП, определяемое в соответствии с критериями KDIGO. Женщины составили 51% пациентов, средний возраст – 61,74±1,5 года. Наиболее частым ССЗ являлась гипертоническая болезнь как у мужчин, так и у женщин – 52 и 39% соответственно.
Результаты. Развитие КИ-ОПП отмечалось у 2 (3,92%) больных. При этом статистически значимых взаимосвязей (р<0,05) между факторами риска и развитием данного осложнения установить не удалось.
Заключение. ССЗ могут повышать риск развития КИ-ОПП при проведении КТ с внутривенным контрастированием, в связи с чем рекомендуется оценивать концентрацию сывороточного креатинина у таких пациентов. Необходимы дальнейшие наблюдения для полноценной оценки риска развития КИ-ОПП.
Ключевые слова: контраст-индуцированное острое повреждение почек, контраст-индуцированная нефропатия, контраст-ассоциированное острое повреждение почек, компьютерная томография, контрастное вещество, сердечно-сосудистые заболевания, прогноз
________________________________________________
Materials and methods. In prospective observational study (ClinicalTrials.gov ID NCT04666389) were included 51 patients with CVD undergoing CT with intravenous contrast media administration. The primary endpoint was CI-AKI according to KDIGO criteria [the 25% rise (or 0.5 mg/dl) of serum creatinine from baseline assessed 48–72 hours after administration of contrast media]. There were 51% of women included in the study. The average age was 61.74±1.5. The most frequent cardiovascular disease was hypertension in both men and women – 52 and 39% respectively.
Results. CI-AKI was diagnosed in 2 (3.92%) patients. At the same time, it was not possible to establish statistically significant relationship (p<0.05) between risk factors and the development of CI-AKI.
Conclusion. Cardiovascular diseases may increase the risk of CI-AKI after CT with intravenous contrast media administration. Therefore, it is recommended to evaluate the serum creatinine concentration in such patients.
Keywords: contrast-induced acute kidney injury, contrast-induced nephropathy, contrast-associated acute kidney injury, computed tomography, contrast media, cardiovascular diseases, prognosis
Полный текст
Список литературы
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4. Castaldo P, Frascà GM, Brigante F, et al. Low incidence of nephrotoxicity following intravenous administration of iodinated contrast media: a prospective study. Eur Radiol. 2019;29(7):3927-34. DOI:10.1007/s00330-019-06147-2
5. Rudnick MR, Leonberg-Yoo AK, Litt HI, et al. The controversy of contrast-induced nephropathy with intravenous contrast: what is the risk? Am J Kidney Dis. 2020;75(1):105-13. DOI:10.1053/j.ajkd.2019.05.022
6. Neilipovitz J, Hiremath S, Rosenberg H, et al. CJEM Debate Series: contrast-enhanced imaging should not be withheld for emergency department patients as contrast-induced acute kidney injury is very uncommon. Can J Emerg Med. 2021;23(4):432-6. DOI:10.1007/s43678-021-00126-7
7. Kooiman J, Pasha SM, Zondag W, et al. Meta-analysis: serum creatinine changes following contrast enhanced CT imaging. Eur J Radiol. 2012;81(10):2554-61. DOI:10.1016/j.ejrad.2011.11.020
8. Aycock RD, Westafer LM, Boxen JL, et al. Acute kidney injury after computed tomography: a meta-analysis. Ann Emerg Med. 2018;71(1):44-53.e4. DOI:10.1016/j.annemergmed.2017.06.041
9. Demchuk OV, Sukmanova IA, Ponomarenko IV, Elykomov VA. Contrast-induced nephropathy in patients with acute coronary syndrome: Clinical significance, diagnosis, prophylaxis. Cardiovascular Therapy and Prevention. 2020;19(2):2255. DOI:10.15829/1728-8800-2019-2255
10. Kellum JA, Lameire N, Aspelin P, et al. Kidney disease: Improving global outcomes (KDIGO) acute kidney injury work group. KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl. 2012;2(1):1-138. DOI:10.1038/kisup.2012.1
11. Barrett BJ, Katzberg RW, Thomsen HS, et al. Contrast-induced nephropathy in patients with chronic kidney disease undergoing computed tomography: A double-blind comparison of iodixanol and iopamidol. Invest Radiol. 2006;41(11):815-21. DOI:10.1097/01.rli.0000242807.01818.24
12. Park JH, Shin HJ, Choi JY, et al. Is there association between statin usage and contrast-associated acute kidney injury after intravenous administration of iodine-based contrast media in enhanced computed tomography? Eur Radiol. 2020;30(10):5261-71. DOI:10.1007/s00330-020-06897-4
13. Andra CA, Khairul A, Arina CA, et al. Contrast induced nephropathy in hypertensive patients after elective percutaneous coronary intervention. IOP Conf Ser Earth Environ Sci. 2018:130(1). DOI:10.1088/1755-1315/130/1/012006
14. Mironov OIu, Sivakova OA, Fomin VV. Contrast-induced nephropathy in patients with stable coronary artery disease and 1-year prognosis. Eurasian Hear J. 2020;1685(3):100-5. DOI:10.38109/2225-1685-2020-3-100-105
15. Rim MY, Ro H, Kang WC, et al. The effect of renin-angiotensin-aldosterone system blockade on contrast-induced acute kidney injury: a propensity-matched study. Am J Kidney Dis. 2012;60(4):576-82. DOI:10.1053/J.AJKD.2012.04.017
16. Peng F, Su J, Lin J, Niu W. Impact of renin-angiotensin-aldosterone system-blocking agents on the risk of contrast-induced acute kidney injury: a prospective study and meta-analysis. J Cardiovasc Pharmacol. 2015;65(3):262-8. DOI:10.1097/FJC.0000000000000189
2. Mehran R, Nikolsky E. Contrast-induced nephropathy: definition, epidemiology, and patients at risk. Kidney Int Suppl. 2006;100:S11-5. DOI:10.1038/sj.ki.5000368
3. Ozkok S, Ozkok A. Contrast-induced acute kidney injury: A review of practical points. World J Nephrol. 2017;6(3):86-99. DOI:10.5527/wjn.v6.i3.86
4. Castaldo P, Frascà GM, Brigante F, et al. Low incidence of nephrotoxicity following intravenous administration of iodinated contrast media: a prospective study. Eur Radiol. 2019;29(7):3927-34. DOI:10.1007/s00330-019-06147-2
5. Rudnick MR, Leonberg-Yoo AK, Litt HI, et al. The controversy of contrast-induced nephropathy with intravenous contrast: what is the risk? Am J Kidney Dis. 2020;75(1):105-13. DOI:10.1053/j.ajkd.2019.05.022
6. Neilipovitz J, Hiremath S, Rosenberg H, et al. CJEM Debate Series: contrast-enhanced imaging should not be withheld for emergency department patients as contrast-induced acute kidney injury is very uncommon. Can J Emerg Med. 2021;23(4):432-6. DOI:10.1007/s43678-021-00126-7
7. Kooiman J, Pasha SM, Zondag W, et al. Meta-analysis: serum creatinine changes following contrast enhanced CT imaging. Eur J Radiol. 2012;81(10):2554-61. DOI:10.1016/j.ejrad.2011.11.020
8. Aycock RD, Westafer LM, Boxen JL, et al. Acute kidney injury after computed tomography: a meta-analysis. Ann Emerg Med. 2018;71(1):44-53.e4. DOI:10.1016/j.annemergmed.2017.06.041
9. Demchuk OV, Sukmanova IA, Ponomarenko IV, Elykomov VA. Contrast-induced nephropathy in patients with acute coronary syndrome: Clinical significance, diagnosis, prophylaxis. Cardiovascular Therapy and Prevention. 2020;19(2):2255. DOI:10.15829/1728-8800-2019-2255
10. Kellum JA, Lameire N, Aspelin P, et al. Kidney disease: Improving global outcomes (KDIGO) acute kidney injury work group. KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl. 2012;2(1):1-138. DOI:10.1038/kisup.2012.1
11. Barrett BJ, Katzberg RW, Thomsen HS, et al. Contrast-induced nephropathy in patients with chronic kidney disease undergoing computed tomography: A double-blind comparison of iodixanol and iopamidol. Invest Radiol. 2006;41(11):815-21. DOI:10.1097/01.rli.0000242807.01818.24
12. Park JH, Shin HJ, Choi JY, et al. Is there association between statin usage and contrast-associated acute kidney injury after intravenous administration of iodine-based contrast media in enhanced computed tomography? Eur Radiol. 2020;30(10):5261-71. DOI:10.1007/s00330-020-06897-4
13. Andra CA, Khairul A, Arina CA, et al. Contrast induced nephropathy in hypertensive patients after elective percutaneous coronary intervention. IOP Conf Ser Earth Environ Sci. 2018:130(1). DOI:10.1088/1755-1315/130/1/012006
14. Mironov OIu, Sivakova OA, Fomin VV. Contrast-induced nephropathy in patients with stable coronary artery disease and 1-year prognosis. Eurasian Hear J. 2020;1685(3):100-5. DOI:10.38109/2225-1685-2020-3-100-105
15. Rim MY, Ro H, Kang WC, et al. The effect of renin-angiotensin-aldosterone system blockade on contrast-induced acute kidney injury: a propensity-matched study. Am J Kidney Dis. 2012;60(4):576-82. DOI:10.1053/J.AJKD.2012.04.017
16. Peng F, Su J, Lin J, Niu W. Impact of renin-angiotensin-aldosterone system-blocking agents on the risk of contrast-induced acute kidney injury: a prospective study and meta-analysis. J Cardiovasc Pharmacol. 2015;65(3):262-8. DOI:10.1097/FJC.0000000000000189
2. Mehran R, Nikolsky E. Contrast-induced nephropathy: definition, epidemiology, and patients at risk. Kidney Int Suppl. 2006;100:S11-5. DOI:10.1038/sj.ki.5000368
3. Ozkok S, Ozkok A. Contrast-induced acute kidney injury: A review of practical points. World J Nephrol. 2017;6(3):86-99. DOI:10.5527/wjn.v6.i3.86
4. Castaldo P, Frascà GM, Brigante F, et al. Low incidence of nephrotoxicity following intravenous administration of iodinated contrast media: a prospective study. Eur Radiol. 2019;29(7):3927-34. DOI:10.1007/s00330-019-06147-2
5. Rudnick MR, Leonberg-Yoo AK, Litt HI, et al. The controversy of contrast-induced nephropathy with intravenous contrast: what is the risk? Am J Kidney Dis. 2020;75(1):105-13. DOI:10.1053/j.ajkd.2019.05.022
6. Neilipovitz J, Hiremath S, Rosenberg H, et al. CJEM Debate Series: contrast-enhanced imaging should not be withheld for emergency department patients as contrast-induced acute kidney injury is very uncommon. Can J Emerg Med. 2021;23(4):432-6. DOI:10.1007/s43678-021-00126-7
7. Kooiman J, Pasha SM, Zondag W, et al. Meta-analysis: serum creatinine changes following contrast enhanced CT imaging. Eur J Radiol. 2012;81(10):2554-61. DOI:10.1016/j.ejrad.2011.11.020
8. Aycock RD, Westafer LM, Boxen JL, et al. Acute kidney injury after computed tomography: a meta-analysis. Ann Emerg Med. 2018;71(1):44-53.e4. DOI:10.1016/j.annemergmed.2017.06.041
9. Demchuk OV, Sukmanova IA, Ponomarenko IV, Elykomov VA. Contrast-induced nephropathy in patients with acute coronary syndrome: Clinical significance, diagnosis, prophylaxis. Cardiovascular Therapy and Prevention. 2020;19(2):2255. DOI:10.15829/1728-8800-2019-2255
10. Kellum JA, Lameire N, Aspelin P, et al. Kidney disease: Improving global outcomes (KDIGO) acute kidney injury work group. KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl. 2012;2(1):1-138. DOI:10.1038/kisup.2012.1
11. Barrett BJ, Katzberg RW, Thomsen HS, et al. Contrast-induced nephropathy in patients with chronic kidney disease undergoing computed tomography: A double-blind comparison of iodixanol and iopamidol. Invest Radiol. 2006;41(11):815-21. DOI:10.1097/01.rli.0000242807.01818.24
12. Park JH, Shin HJ, Choi JY, et al. Is there association between statin usage and contrast-associated acute kidney injury after intravenous administration of iodine-based contrast media in enhanced computed tomography? Eur Radiol. 2020;30(10):5261-71. DOI:10.1007/s00330-020-06897-4
13. Andra CA, Khairul A, Arina CA, et al. Contrast induced nephropathy in hypertensive patients after elective percutaneous coronary intervention. IOP Conf Ser Earth Environ Sci. 2018:130(1). DOI:10.1088/1755-1315/130/1/012006
14. Mironov OIu, Sivakova OA, Fomin VV. Contrast-induced nephropathy in patients with stable coronary artery disease and 1-year prognosis. Eurasian Hear J. 2020;1685(3):100-5. DOI:10.38109/2225-1685-2020-3-100-105
15. Rim MY, Ro H, Kang WC, et al. The effect of renin-angiotensin-aldosterone system blockade on contrast-induced acute kidney injury: a propensity-matched study. Am J Kidney Dis. 2012;60(4):576-82. DOI:10.1053/J.AJKD.2012.04.017
16. Peng F, Su J, Lin J, Niu W. Impact of renin-angiotensin-aldosterone system-blocking agents on the risk of contrast-induced acute kidney injury: a prospective study and meta-analysis. J Cardiovasc Pharmacol. 2015;65(3):262-8. DOI:10.1097/FJC.0000000000000189
________________________________________________
2. Mehran R, Nikolsky E. Contrast-induced nephropathy: definition, epidemiology, and patients at risk. Kidney Int Suppl. 2006;100:S11-5. DOI:10.1038/sj.ki.5000368
3. Ozkok S, Ozkok A. Contrast-induced acute kidney injury: A review of practical points. World J Nephrol. 2017;6(3):86-99. DOI:10.5527/wjn.v6.i3.86
4. Castaldo P, Frascà GM, Brigante F, et al. Low incidence of nephrotoxicity following intravenous administration of iodinated contrast media: a prospective study. Eur Radiol. 2019;29(7):3927-34. DOI:10.1007/s00330-019-06147-2
5. Rudnick MR, Leonberg-Yoo AK, Litt HI, et al. The controversy of contrast-induced nephropathy with intravenous contrast: what is the risk? Am J Kidney Dis. 2020;75(1):105-13. DOI:10.1053/j.ajkd.2019.05.022
6. Neilipovitz J, Hiremath S, Rosenberg H, et al. CJEM Debate Series: contrast-enhanced imaging should not be withheld for emergency department patients as contrast-induced acute kidney injury is very uncommon. Can J Emerg Med. 2021;23(4):432-6. DOI:10.1007/s43678-021-00126-7
7. Kooiman J, Pasha SM, Zondag W, et al. Meta-analysis: serum creatinine changes following contrast enhanced CT imaging. Eur J Radiol. 2012;81(10):2554-61. DOI:10.1016/j.ejrad.2011.11.020
8. Aycock RD, Westafer LM, Boxen JL, et al. Acute kidney injury after computed tomography: a meta-analysis. Ann Emerg Med. 2018;71(1):44-53.e4. DOI:10.1016/j.annemergmed.2017.06.041
9. Demchuk OV, Sukmanova IA, Ponomarenko IV, Elykomov VA. Contrast-induced nephropathy in patients with acute coronary syndrome: Clinical significance, diagnosis, prophylaxis. Cardiovascular Therapy and Prevention. 2020;19(2):2255. DOI:10.15829/1728-8800-2019-2255
10. Kellum JA, Lameire N, Aspelin P, et al. Kidney disease: Improving global outcomes (KDIGO) acute kidney injury work group. KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl. 2012;2(1):1-138. DOI:10.1038/kisup.2012.1
11. Barrett BJ, Katzberg RW, Thomsen HS, et al. Contrast-induced nephropathy in patients with chronic kidney disease undergoing computed tomography: A double-blind comparison of iodixanol and iopamidol. Invest Radiol. 2006;41(11):815-21. DOI:10.1097/01.rli.0000242807.01818.24
12. Park JH, Shin HJ, Choi JY, et al. Is there association between statin usage and contrast-associated acute kidney injury after intravenous administration of iodine-based contrast media in enhanced computed tomography? Eur Radiol. 2020;30(10):5261-71. DOI:10.1007/s00330-020-06897-4
13. Andra CA, Khairul A, Arina CA, et al. Contrast induced nephropathy in hypertensive patients after elective percutaneous coronary intervention. IOP Conf Ser Earth Environ Sci. 2018:130(1). DOI:10.1088/1755-1315/130/1/012006
14. Mironov OIu, Sivakova OA, Fomin VV. Contrast-induced nephropathy in patients with stable coronary artery disease and 1-year prognosis. Eurasian Hear J. 2020;1685(3):100-5. DOI:10.38109/2225-1685-2020-3-100-105
15. Rim MY, Ro H, Kang WC, et al. The effect of renin-angiotensin-aldosterone system blockade on contrast-induced acute kidney injury: a propensity-matched study. Am J Kidney Dis. 2012;60(4):576-82. DOI:10.1053/J.AJKD.2012.04.017
16. Peng F, Su J, Lin J, Niu W. Impact of renin-angiotensin-aldosterone system-blocking agents on the risk of contrast-induced acute kidney injury: a prospective study and meta-analysis. J Cardiovasc Pharmacol. 2015;65(3):262-8. DOI:10.1097/FJC.0000000000000189
Авторы
А.А. Васин*, О.Ю. Миронова, В.В. Фомин
ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет), Москва, Россия
*vasin_dr@mail.ru
Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
*vasin_dr@mail.ru
ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет), Москва, Россия
*vasin_dr@mail.ru
________________________________________________
Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
*vasin_dr@mail.ru
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