| Background and purpose:Iodixanol,a commonly used nonionic dimer,iso-osmolar iodine contrast medium,is the only intravascular iso-osmolar iodine contrast medium that is approved in clinic.Iodixanol has many advantages such as less irritating to heart and vascular endothelium,low nephrotoxicity,high clinical safety,enhance patient comfort,and less disturbance to circulatory system.It is recognized and recommended by many clinical guidelines and expert consensus at home and abroad.Previous studies have confirmed its renal safety,especially for high-risk patients with diabetes mellitus and / or renal insufficiency,there is a lower risk of renal impairment.Due to the concern of nephrotoxicity of contrast medium,however,existing studies predominantly focused on the influence of iodixanol on renal function within recommended dose by guidelines.Few studies evaluated the nephrotoxicity of high doses of iodixanol.With the development of interventional radiology,further understanding and interventions have been implemented on complex coronary artery disease.However,high doses of contrast medium is often needed in complex coronary artery disease during percutaneous coronary intervention(PCI)procedure.Therefore,it is necessary to evaluate the renal safety of high-dose contrast medium during PCI.This study evaluate the change of renal function pre-and post-PCI after administrating high-dose iodixanol(> 300ml),and explore the effect of high-dose iodixanol on renal function.Methods:This was a multicenter retrospective study which included clinical data from 4 centers:the Second Affiliated Hospital of Army Medical University,Fuling Central Hospital of Chongqing,Fifth People’s Hospital of Chongqing,and the Ninth People’s Hospital of Chongqing.Data were collected from patients who had undergone PCI and received a high-dose iodixanol(>300 ml)during PCI procedure between October 2015 and December2017.The incidence and risk factors of contrast-induced acute kidney injury(CI-AKI)was analyzed by reviewing and summarizing medical records of patients.Results:1.Initially,a total of 676 patients who received high-dose iodixanol(>300 ml)during PCI procedures met the inclusive criteria,25 patients met the exclusive criteria.The remaining 651 patients met the study criteria.2.The incidence of CI-AKI in all included cases is 3.5%(23/651),and 3.9%(8/204)in patients with diabetes.Only 1 patient who had a history of chronic kidney disease(CKD stage 4)underwent hemodialysis after PCI due to emergent situation.None of the remaining patients required emergency hemodialysis or peritoneal dialysis.Oliguria and anuria symptoms were not observed in any patient.3.Two groups were defined according to the dose of iodixanol used during PCI procedure,300-500 ml and >500ml.There were no significant differences in the incidence of CI-AKI between the two group(3.9% vs 1.7%,P=0.405);As was in diabetes mellitus subgroup(4.3% vs 2.3%,P=0.469).4.In patients with an estimated glomerular filtration rate(e GFR)<60 ml/min/1.73m2,the incidence of CI-AKI was 2.6%.In low-risk,moderate-risk,high-risk and very high-risk patients,stratified by the Mehran risk score,the incidence of CI-AKI was5.1%,2.6%,3.3%and 4.3%,respectively.There were no apparent discrepancy among different risk stratification.In diabetes mellitus subgroup,there was no patients included in low-risk stratification,there was also no apparent discrepancy among the other three risk stratification(3.8% vs 3.5% vs 5.9,P=0.777).5.Multivariate Logistic regression analysis demonstrated that female(OR:4.044,P=0.004)and CKD(OR:9.556,P=0.005)were independent risk factors for CI-AKI,however,anemia(OR:7.524,P=0.033)and CKD(OR:30.942,P=0.046)were independent risk factors for CI-AKI in diabetes mellitus subgroup,but not contrast volume.Conclusions:A high-dose(>300 mL)of iodixanol administrated during PCI procedure does not result in high incidences of CI-AKI. |
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