背景:由于不断需要技术改进以确保正确的诊断和精确的治疗,使用造影剂的成像检查已成为不可避免和不可缺少的。然而,在晚期肾衰竭患者中,造影剂对肾功能的长期影响尚不清楚.本研究旨在研究肾功能衰竭患者造影剂暴露与肾功能长期趋势之间的关系。
方法:这项回顾性队列研究纳入了2012年4月至2020年12月在日本医疗机构就诊的明确诊断为慢性肾脏病的患者。该队列分为对比剂治疗组和非对比剂治疗组。评价指标为对比剂暴露次数和肾功能下降。根据观察到的慢性肾脏疾病阶段趋势和来自各种指南的肾小球滤过率对应表来计算肾功能下降。还进行了针对肾功能变化的分层分析,同时考虑了慢性肾脏疾病进展的加速。
结果:调整患者背景与倾向评分匹配后,两组均纳入333例患者。对比增强组和非对比增强组每例观察期分别为5.3±2.1和4.9±2.2年,分别。对比增强组的基线估计肾小球滤过率为55.2±17.8mL/min/1.73m2(P=0.65)。虽然两组之间仅略有不同,对比剂治疗组的肾小球滤过率变化为1.1±3.3mL/min/1.73m2/年,并且随着对比剂暴露而趋于更高.分层分析显示,对比剂治疗组和非对比剂治疗组较多,肾功能改变患者的年肾小球滤过率变化分别为7.9±7.1mL/min/1.73m2/年和4.7±3.6mL/min/1.73m2/年,分别为(1.69倍,P<0.05)。
结论:我们能够确定预防与造影剂暴露相关的不良肾脏结局的成功措施的临床趋势。然而,造影剂暴露频率的增加对改变患者的肾功能有长期影响。与造影剂相关的适当治疗选择可以控制慢性肾脏疾病。
With the constant need for technique improvement for ensuring correct diagnoses and precise treatment, imaging examinations that use contrast media have become unavoidable and indispensable. However, the long-term effects of contrast media on renal function remain unclear in populations with advanced renal failure. This study aimed to examine the relationship between contrast media exposure and long-term trends in renal function in patients with renal failure.
This retrospective cohort study included patients with a definitive diagnosis of chronic kidney disease who visited medical institutions in Japan between April 2012 and December 2020. The cohort was divided into contrast agent therapy and non-contrast agent therapy groups. The assessment indices were the number of contrast exposures and renal function decline. Renal function decline was calculated based on observed chronic kidney disease stage trends and glomerular filtration rate correspondence tables sourced from various guidelines. A stratified analysis focusing on changes in renal function while accounting for the acceleration of chronic kidney disease progression was also performed.
After adjusting for patient background with propensity score matching, 333 patients each were included in both groups. The observation period was 5.3 ± 2.1 and 4.9 ± 2.2 years per case in the contrast-enhanced and non-contrast-enhanced groups, respectively. The baseline estimated glomerular filtration rate at the beginning of the observation period was 55.2 ± 17.8 mL/min/1.73 m2 in the contrast-enhanced groups (P = 0.65). Although only slightly different in both groups, the glomerular filtration rate change was 1.1 ± 3.3 mL/min/1.73 m2/year in the contrast agent therapy group and tended to be higher with contrast media exposure. Stratified analysis showed that the annual glomerular filtration rate changes in patients with more contrast media exposures and altered renal function were 7.9 ± 7.1 mL/min/1.73 m2/year and 4.7 ± 3.6 mL/min/1.73 m2/year in the contrast agent therapy and non-contrast agent therapy groups, respectively (1.69 times, P < 0.05).
We were able to identify a clinical trend of successful measures for preventing adverse renal outcomes associated with contrast media exposure. However, increased frequency of contrast media exposure has a long-term effect on renal function in patients with altered it. Appropriate treatment choices related to contrast media may control chronic kidney disease.