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Minimierung kontrastmittelinduzierter Nephropathien

Strategien bei CTA, Katheterangiographie und Interventionen

Minimizing contrast-induced nephropathy

Strategies in CTA, catheter angiography and interventions

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Zusammenfassung

Ziel der vorliegenden Arbeit ist die Diskussion von Strategien zur Minimierung der Kontrastmittel(KM)-Dosen bei Patienten mit dem Risiko einer KM-induzierten Nephropathie („contrast medium-induced nephropathy“, CIN) nach Computertomographie(CT)-Angiographie, perkutaner Katheterangiographie (PCA) und vaskulärer Intervention (PVI). Allgemein scheint ein Verhältnis zwischen der Jodmenge in Gramm und der geschätzten glomerulären Filtrationsrate (g-I/eGFR) ≥1,0 ein signifikanter und unabhängiger Prädiktor einer CIN bei CTA und Koronarinterventionen zu sein. Bei Patienten mit hohem CIN-Risiko (z. B. eGFR <45 ml/min oder multiple Risikofaktoren) wird empfohlen, die g-I/eGFR-Ratio <0,5 zu halten. Bei Patienten mit Niereninsuffizienz kann eine 80-kVp-CTA mit 100–150 mg I/kg durchgeführt werden, dabei muss die Leistung der Röntgenröhre erhöht werden, um den Kontrast-Rausch-Abstand auf einem akzeptablen Niveau zu halten. Eine periphere PCA/PVI auf der Basis der digitalen Subtraktionstechnik kann mit 75–150 mg I/ml erfolgen oder auch weniger, wenn das Gerät die manuelle Einstellung des Röntgenröhrenpotenzials erlaubt. Koronararteriographien/-interventionen können bei 140–150 mg I/ml erfolgen, d. h. mit weniger als der Hälfte der üblicherweise verwendeten Konzentrationen (~320–370 mg I/ml), vor allem bei dünneren Patienten mit erhöhter Jodabschwächung aufgrund der automatischen Herabregulierung des Röntgenröhrenpotenzials.

Die englische Volltextversion dieses Beitrags ist über SpringerLink (unter „Supplemental“) verfügbar.

Abstract

The aim of the present paper is to discuss strategies to minimize contrast medium (CM) doses in patients at risk of CM-induced nephropathy (CIN) after computed tomographic angiography (CTA), and percutaneous catheter angiography (PCA) and vascular interventions (PVI). In general a gram-iodine (g-I)/eGFR ratio ≥1.0 appears to be a significant and independent predictor of CIN in CTA and coronary interventions. In high CIN-risk patients (e.g., eGFR <45 ml/min or multiple risk factors), it is recommended to keep the g-I/eGFR ratio <0.5. In azotemic patients, 80 kVp CTA may be accomplished with 100–150 mg I/kg while x-ray tube loading must be increased to maintain the contrast-to-noise ratio at an acceptable level. Peripheral PCA/PVI based on digital subtraction technique may be performed with 75–150 mg I/ml, or even lower if the equipment permits manual setting of the x-ray tube potential. Coronary arteriography/interventions may be achieved with 140–150 mg I/ml, i.e., less than half the routinely used concentrations (~320–370 mg I/ml), especially in thinner patients with increased iodine attenuation due to automatic down regulation of the x-ray tube potential.

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehung(en) hin: Der Autor hat das Computerprogramm OmniVis entwickelt, welches an GE Healthcare mit dem Recht zum Vertrieb verkauft wurde. Er hält gegen Bezahlung Vorträge für verschiedene Kontrastmittel herstellende pharmazeutische Unternehmen.

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  1. Department of Diagnostic Radiology, Lasarettet Trelleborg, University of Lund, Hedvägen 46, 23185, Trelleborg, Schweden

    U. Nyman MD, PhD

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Nyman, U. Minimierung kontrastmittelinduzierter Nephropathien. Gefässchirurgie 16, 469–480 (2011). https://doi.org/10.1007/s00772-011-0927-x

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