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Low-molecular-weight dextran for optical coherence tomography may not be protective against kidney injury in patients with renal insufficiency

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World Journal of Nephrology 2021年第2期10卷 8-20页

作者： Toru Misawa Tomoyo Sugiyama Yoshihisa Kanaji Masahiro Hoshino Masao Yamaguchi Masahiro Hada Tatsuhiro Nagamine Kai Nogami yumi yasui Eisuke Usui Tetsumin Lee Taishi Yonetsu Tetsuo Sasano Tsunekazu Kakuta Department of Cardiovascular Medicine Tsuchiura Kyodo General HospitalIbaraki 300-0028Japan Department of Interventional Cardiology Tokyo Medical and Dental UniversityTokyo 113-8519Japan Department of Cardiovascular Medicine Tokyo Medical and Dental UniversityTokyo 113-8519Japan

BACKGROUND Low-molecular-weight dextran(LMWD)is considered a safe alternative to contrast media for blood displacement during optical coherence tomography(OCT)*** To investigate whether the use of LMWD for OCT is protective against kidney injury in patients with advanced renal *** In this retrospective cohort study,we identified 421 patients with advanced renal insufficiency(estimated glomerular filtration rate<45 mL/min/1.73 m2)who underwent coronary angiography or percutaneous coronary intervention;79 patients who used additional LMWD for OCT imaging(LMWD group)and 342 patients who used contrast medium exclusively(control group).We evaluated the differences between these two groups and performed a propensity score-matched subgroup *** The median total volume of contrast medium was 133.0 mL in the control group vs 140.0 mL in the LMWD *** baseline renal function was not statistically different between these two groups,the LMWD group demonstrated a strong trend toward the progression of renal insufficiency as indicated by the greater change in serum creatinine level during the 1-year follow-up compared with the control *** in the LMWD group experienced worsening renal function more frequently than patients in the control *** score matching adjusted for total contrast media volume consistently indicated a trend toward worsening renal function in the LMWD group at the 1-year *** serum creatinine at 1-year follow-up was significantly greater in the LMWD group than that in the control group[0.06(-0.06,0.29)vs-0.04(-0.23,0.08)mg/dL,P=0.001],despite using similar contrast *** OCT using LMWD may not be protective against worsening renal function in patients with advanced renal insufficiency.

关键词： Coronary artery disease Kidney injury Contrast media Dextran Optical coherence tomography Renal insufficiency

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