Effect of contrast media on renal function in elderly patients suffering from ischemic cerebral vascular disease and undergoing angiography / 中华老年医学杂志

ABSTRACT

Objective To investigate the effects of the low-osmolar nonionic contrast media on renal function in elderly patients suffering from ischemic cerebral vascular disease and undergoing angiography.To study the incidence and risk factors for contrast-induced nephropathy (CIN).Methods 276 elderly patients who were going to receive selective cranial angiography and bilateral renal angiography were included.The 0.9 ％ sodium chloride (1 ml · kg-1 · h-1) was administered in all patients 6 hours before and 12 hours after contrast media administration.No patients suffered from obviously congestive heart failure.The levels of serum creatinine (Scr) and serum urea nitrogen (SUN) were measured 3 days before and at day 1,2,6 after the administration of contrast media respectively.Then creatinine clearance rate (Ccr) was calculated.Multivariate predictors of contrastinduced nephropathy were determined by logistic regression.Results Among the 276 patients,CIN occurred in 19 patients (6.9％),among whom 4 patients suffered from severe renal artery stenosis and received percutaneous transluminal renal angioplasty (PTRA) at 1 week after undergoing angiography.The renal function in the other 15 cases with CIN were recovered to baseline 1evel 3 months after the use of contrast media.No patients underwent a maintenance hemodialysis.In the 19 patients with CIN,the levels of SUN and Scr were higher and Ccr was lower at day 1 and 2 after angiography than before the procedure (all P ＜ 0.05),but the parameters were decreased to preoperative level at day 6 after angiography (all P＞0.05).Logistic regression analysis showed that renal dysfunction,diabetes mellitus and severe renal artery stenosis were the major risk factors for contrast-induced nephropathy.Conclusions Low-osmoiar nonionic contrast used in angiography is safe for elderly patients if adequately hydrated with 0.9 ％ sodium chloride.The clinical risk factors for CIN are renal dysfunction,diabetes mellitus and severe renal artery stenosis.