目的:评价肾病患者静脉使用碘化造影剂(ICM)指南的质量,并比较它们之间的建议。
方法:我们检索了四个文献数据库,八个指南图书馆,以及2018年1月至2023年6月期间发表的10个放射学学会主页,以确定肾脏疾病患者静脉使用ICM的英文和中文指南.科学评估了指南的质量,透明,和适用的排名(STAR)工具。
结果:包括十条指南,中位STAR评分为46.0(范围28.5-61.5)。指南在“建议”领域表现良好(31/40,78%),而“注册表”(0/20,0%)和“协议”域(0/20,0%)较差。9个指南推荐估计的肾小球滤过率(eGFR)<30mL/min/1.73m2作为转诊患者的截止值,以讨论ICM给药的风险-收益平衡。三项指南进一步建议eGFR<45mL/min/1.73m2和高风险因素的患者也需要参考。在肾功能测试和ICM给药之间可接受的时间间隔中发现了可变的建议,在扫描和重复扫描之间。九种指南建议使用等渗或低渗ICM,虽然ICM的给药尚未达成共识。九项指南支持使用ICM后的水合作用,但是他们的协议各不相同。不建议将药物或血液净化治疗作为预防手段。
结论:肾脏病患者静脉内使用ICM指南具有异质性。科学协会可能会考虑就可变时间和协议的有争议的建议发表联合声明。
■指南的异构质量,和他们有争议的建议,在工作流时间安排中留出空白,给药,以及对肾脏疾病患者进行对比增强CT扫描的给药后水合方案,呼吁提供更多证据以建立更安全,更可行的工作流程。
结论:•关于肾病患者使用碘化造影剂的指南各不相同。•在工作流时间安排方面仍然存在争议,对比剂剂量,和给药后水合方案。•鼓励调查建立更安全的碘化造影剂使用工作流程。
OBJECTIVE: To appraise the quality of guidelines on intravenous iodinated contrast media (ICM) use in patients with kidney disease, and to compare the recommendations among them.
METHODS: We searched four literature databases, eight guideline libraries, and ten homepages of radiological societies to identify English and Chinese guidelines on intravenous ICM use in patients with kidney disease published between January 2018 and June 2023. The quality of the guidelines was assessed with the Scientific, Transparent, and Applicable Rankings (STAR) tool.
RESULTS: Ten guidelines were included, with a median STAR score of 46.0 (range 28.5-61.5). The guidelines performed well in \"Recommendations\" domain (31/40, 78%), while poor in \"Registry\" (0/20, 0%) and \"Protocol\" domains (0/20, 0%). Nine guidelines recommended estimated glomerular filtration rate (eGFR) < 30 mL/min/1.73 m2 as the cutoff for referring patients to discuss the risk-benefit balance of ICM administration. Three guidelines further suggested that patients with an eGFR < 45 mL/min/1.73 m2 and high-risk factors also need referring. Variable recommendations were seen in the acceptable time interval between renal function test and ICM administration, and that between scan and repeated scan. Nine guidelines recommended to use iso-osmolar or low-osmolar ICM, while no consensus has been reached for the dosing of ICM. Nine guidelines supported hydration after ICM use, but their protocols varied. Drugs or blood purification therapy were not recommended as preventative means.
CONCLUSIONS: Guidelines on intravenous ICM use in patients with kidney disease have heterogeneous quality. The scientific societies may consider joint statements on controversial recommendations for variable timing and protocols.
UNASSIGNED: The heterogeneous quality of guidelines, and their controversial recommendations, leave gaps in workflow timing, dosing, and post-administration hydration protocols of contrast-enhanced CT scans for patients with kidney diseases, calling for more evidence to establish a safer and more practicable workflow.
CONCLUSIONS: • Guidelines concerning iodinated contrast media use in kidney disease patients vary. • Controversy remains in workflow timing, contrast dosing, and post-administration hydration protocols. • Investigations are encouraged to establish a safer iodinated contrast media use workflow.