《对比剂肾病》ppt课件.ppt

* * CI-AKI was defined as a 0.3 (mg/dL) or 50% increase in peak serum creatinine from baseline or new onset of dialysis-dependent renal failure according to the AKIN criteria during the index catheterization Admission Background—Previous work on contrast-induced acute kidney injury (CI-AKI) has identified contrast volume as a risk factor and suggested that there is a maximum allowable contrast dose (MACD) above which the risk of CI-AKI is markedly increased. We hypothesized that there is a relationship between contrast volume and CI-AKI and that there might be reason to track incremental contrast volumes above and below the MACD limit. Methods and Results—Consecutive patients undergoing percutaneous coronary intervention (PCI) were prospectively enrolled from 2000 to 2008 (n10 065). Patients on dialysis before PCI were excluded (n155). MACD was defined as (5 mLbody weight [kg])/baseline serum creatinine [mg/dL]) and divided into categories in which 1.0 reflects the MACD limit: MACD ratios (0.5, 0.5 to 0.75, and 0.75 to 1.0) and MACD (1.0 to 1.5, 1.5 to 2.0, and 2.0). CI-AKI was defined as a 0.3 (mg/dL) or 50% increase in serum creatinine from baseline or new dialysis. Multivariable regression was conducted to evaluate the effect of exceeding the MACD on CI-AKI. Twenty percent of patients exceeded the MACD. Risk-adjusted CI-AKI increased by an average of 45% for each category exceeding the MACD (odds ratio, 1.45; 95% confidence interval, 1.29 to 1.62) Adjusted odds ratios for each category exceeding the MACD were 1.60 (95% confidence interval, 1.29 to 1.97), 2.02 (95% confidence interval, 1.45 to 2.81), and 2.94 (95% confidence interval, 1.93 to 4.48). CI-AKI for contrast dose MACD showed no statistical difference (P0.5). Conclusions—Contrast volume is a key risk factor for CI-AKI and matters the most in the highest-risk patient. The incremental use of contrast beyond the MACD is associated with an increased risk of CI-AKI. * Background—The role of statins in the pre