腎障害患者におけるヨード造影剤使用に関するガイドライン2012

出版社： 東京医学社
著者：
発行日： 2012-04-20
分野： 臨床医学：内科  >  腎臓
ISBN： 9784885632082
電子書籍版： 2012-04-20 （第1版第2刷）
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日常診療でのヨード造影剤を用いた画像診断は、多くの診療科にとって最も重要な検査の一つである。しかし腎機能が低下している患者にとっては造影剤腎症の発症のリスクがあり、いかに回避するかの指針が求められていた。そこで造影画像診断に関わることの多い日本腎臓学会、日本医学放射線学会、日本循環器学会の3つの学会が共同で練り上げ誕生したのがこの画期的なガイドラインである。日常診療において本ガイドラインを有効に活用していただき、多くの患者にとって安全な造影画像診断が行われ、造影剤腎症の発症予防に役立てていただきたい。

目次

  • 腎障害患者におけるヨード造影剤使用に関するガイドライン2012

    ―目次―
    　
    1　腎障害患者におけるヨード造影剤使用に関する
    　　　ガイドラインの概要
    　1．ガイドラインの目的
    　2．本ガイドラインの使用上の注意
    　3．使用した論文の選択とエビデンスレベルと推奨グレード
    　4．外部評価
    　5．今後の予定
    　6．利益相反

    2　造影剤腎症の定義
    　CQ(2)-1　造影剤腎症（contrast induced nephropathy：CIN）は
    　　どのように定義されるか？

    3　リスク・患者評価
    　CQ(3)-1　CKDはCIN発症のリスクを増加させるか？
    　CQ(3)-2　加齢はCIN発症のリスクを増加させるか？
    　CQ(3)-3　糖尿病はCIN発症のリスクを増加させるか？
    　CQ(3)-4　RAS阻害薬使用はCIN発症のリスクを増加させるか？
    　CQ(3)-5　利尿薬使用はCIN発症のリスクを増加させるか？
    　CQ(3)-6　NSAIDs使用はCIN発症のリスクを増加させるか？
    　CQ(3)-7　ビグアナイド系糖尿病薬を服用している患者への
    　　　　　　ヨード造影剤投与は，乳酸アシドーシスのリスクを
    　　　　　　増加させるか？
    　CQ(3)-8　CINの発症はCKD患者の生命予後を増悪させるか？
    　CQ(3)-9　腹膜透析患者への造影剤投与は残存腎機能低下の
    　　　　　　リスクを増加させるか？
    　CQ(3)-10　CINの発症に関するリスクスコアは有用か？

    4　造影剤の種類と量
    　CQ(4)-1　造影剤投与量の減量はCIN発症のリスクを
    　　　　　　減少させるか？
    　CQ(4)-2　低浸透圧造影剤は高浸透圧造影剤と比較して
    　　　　　　CIN発症のリスクを減少させるか？
    　CQ(4)-3　等浸透圧造影剤と低浸透圧造影剤との間でCINの
    　　　　　　発症リスクに違いがあるか？
    　CQ(4)-4　異なる種類の低浸透圧造影剤間でCIN発症のリスクに
    　　　　　　違いがあるか？
    　CQ(4)-5　造影剤の侵襲的（経動脈）投与は，非侵襲的（経静脈）
    　　　　　　投与と比較してCIN発症のリスクを増加させるか？

    5　侵襲的診断法（心臓カテーテル検査など）
    　CQ(5)-1　CKDはCAGによるCIN発症のリスクを増加させるか？
    　CQ(5)-2　CAGにおいて造影剤使用量の減量はCIN発症の
    　　　　　　リスクを減少させるか？
    　CQ(5)-3　CAGの短時間反復検査はCIN発症のリスクを
    　　　　　　増加させるか？
    　CQ(5)-4　CKDはPCIによるCINの発症を増加させるか？
    　CQ(5)-5　CINとコレステロール塞栓症による腎機能低下を
    　　　　　　どのように鑑別できるか？

    6　非侵襲的診断法（造影CTなど）
    　CQ(6)-1　CKDは造影CTによるCIN発症のリスクを増加させるか？
    　CQ(6)-2　造影CTにおいて造影剤投与量の減量はCIN発症の
    　　　　　　リスクを減少させるか？
    　CQ(6)-3　造影CTの短時間反復検査はCIN発症のリスクを
    　　　　　　増加させるか？
    　CQ(6)-4　外来の造影CTは入院の造影CTに比べてCIN発症の
    　　　　　　リスクが高いか？

    7　造影剤腎症の予防法：輸液
    　CQ(7)-1　生理食塩水投与はCIN発症のリスクを減少させるか？
    　CQ(7)-2　飲水は輸液と同等にCIN発症のリスクを減少させるか？
    　CQ(7)-3　重炭酸ナトリウム（重曹）液投与はCIN発症のリスクを
    　　　　　　減少させるか？
    　CQ(7)-4　短時間の輸液は長時間の輸液と同等にCIN発症を
    　　　　　　予防できるか？

    8　造影剤腎症の予防法：薬物療法
    　CQ(8)-1　N-acetylcysteine（NAC）投与はCIN発症のリスクを
    　　　　　　減少させるか？
    　CQ(8)-2　hANP投与はCIN発症のリスクを減少させるか？
    　CQ(8)-3　アスコルビン酸投与はCIN発症のリスクを
    　　　　　　減少させるか？
    　CQ(8)-4　スタチン投与はCIN発症のリスクを減少させるか？

    9　造影剤腎症の予防法：透析
    　CQ(9)-1　CINの発症予防を目的とした造影剤使用後の
    　　　　　　血液透析療法は，CIN発症のリスクを減少させるか？
    　CQ(9)-2　血液透析に比べて，血液濾過はCIN発症のリスクを
    　　　　　　減少させるか？

    10　造影剤腎症の治療法
    　CQ(10)-1　CIN発症後のループ利尿薬投与は腎機能障害の
    　　　　　　　進行を抑制するか？
    　CQ(10)-2　CIN発症後の輸液療法は腎機能障害の進行を
    　　　　　　　抑制するか？
    　CQ(10)-3　CIN発症後の低用量ドーパミン投与は腎機能障害の
    　　　　　　　進行を抑制するか？
    　CQ(10)-4　CIN発症後のhANP投与は腎機能障害の進行を
    　　　　　　　抑制するか？
    　CQ(10)-5　CIN発症後の急性血液浄化療法は腎機能予後を
    　　　　　　　改善するか？

この書籍の参考文献

参考文献のリンクは、リンク先の都合等により正しく表示されない場合がありますので、あらかじめご了承下さい。

本参考文献は電子書籍掲載内容を元にしております。

3 リスク・患者評価

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4 造影剤の種類と量

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15) Katzberg RW, Newhouse JH : Intravenous contrast medium-induced nephrotoxicity : Is the medical risk really as great as we have come to believe- Radiology 2010 ; 256 : 21-28.〔IVa〕
 
16) Chou SH, Wang ZJ, Kuo J, Cabarrus M, Fu Y, Aslam R, Yee J, Zimmet JM, Shunk K, Elicker B, Yeh BM : Persistent renal enhancement after intra-arterial versus intravenous iodixanol administration. Eur J Radiol 2011 ; 80 : 378-386.〔IVb〕
 
17) Lufft V, Lufft LH, Fels LM, Baiyee DE, Tusch G, Galanski M, Olbricht CJ : Contrast media nephropathy : intravenous CT angiography versus intraarterial digital subtraction angiography in renal artery stenosis : a prospective randomized trial. Am J Kidney Dis 2002 ; 40 : 236-242.〔II〕
 
18) Ahuja TS, Niaz N, Agraharkar M : Contrast-induced nephrotoxicity in renal allograft recipients. Clin Nephrol 2000 ; 54 : 11-14.〔IVb〕
 
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20) Becker CR, Reiser MF : Use of iso-osmolar nonionic dimeric contrast media in multidetector row computed tomography angiography for patients with renal impairment. Invest Radiol 2005 ; 40 : 672-675.〔IVa〕
 
21) Barrett BJ, Katzberg RW, Thomsen HS, Chen N, Sahani D, Soulez G, Heiken JP, Lepanto L, Ni ZH, Ni ZH, Nelson R : Contrast-induced nephropathy in patients with chronic kidney disease undergoing computer tomography-a double blind comparison of iodixanol and iopamidol. Invest Radiol 2006 ; 41 : 815-821.〔II〕
 
22) Thomsen HS, Morcos SK, Earley CM, Grazioli L, Bonomo L, Ni Z, Romano L : The ACTIVE trial : comparison of the effects on renal function of iomeprol-400 and iodixanol-320 in patients with chronic kidney disease undergoing abdominal computed tomography. Invest Radiol 2008 ; 43 : 170-178.〔II〕
 
23) Kuhn MJ, Chen N, Sahani DV, Reimer D, van Beek EJ, Heiken JP, So GJ : The PREDICT study : a randomized double-blind comparison of contrast-induced nephropathy after low- or iso-osmolar contrast agent exposure. Am J Roentgenol 2008 ; 191 : 151-157.〔II〕
 
24) Nguyen SA, Suranyi P, Ravenel JG, Randall PK, Romano PB, Strom KA, Costello P, Schoepf UJ : Iso-osmolality versus low-osmolality iodinated contrast medium at intravenous contrast-enhanced CT : effect on kidney function. Radiology 2008 ; 248 : 97-105.〔II〕
 
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26) Sovak M : The need for improved contrast media. Ioxilan : updating design theory. Invest Radiol 1988 ; 23 (Suppl 1) : S79-83.〔VI〕
 

5 侵襲的診断法 ( 心臓カテーテル検査など )

P.36 掲載の参考文献
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2) 白木克典, 大谷速人, 大野善太郎, 竹内亮輔, 平井希俊, 村田耕一郎, 嶋根 章, 吹田浩之, 小野寺知哉, 滝澤明憲 : 当院における心臓カテーテル関連造影剤腎症について. Jpn Circ J 2001 ; 65 : 750. 〔IVb〕
 
3) 藤崎毅一郎, 中山勝, 吉光隆博, 土井俊樹, 田中理恵子, 山田明, 小池清美, 武田一人 : 当院における心臓カテーテル検査後の造影剤腎症の発生頻度. 日腎会誌 2002 ; 44 : 315. 〔IVb〕
 
4) Rihal CS, Textor SC, Grill DE, Berger PB, Ting HH, Best PJ, Singh M, Bell MR, Barsness GW, Mathew V, Garratt KN, Holmes DR Jr : Incidence and prognostic importance of acute renal failure after percutaneous coronary intervention. Circulation 2002 ; 105 : 2259-2264.〔IVb〕
 
5) Abe M, Kimura T, Morimoto T, Furukawa Y, Kita T : Incidence of and risk factors for contrast-induced nephropathy after cardiac catheterization in Japanese patients. Circ J 2009 ; 73 : 1518-1522.〔IVb〕
 
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9) Nyman U : Contrast medium dose-to-GFR ratio : a measure of systemic exposure to predict contrast-induced nephropathy after percutaneous coronary intervention. Acta Radiol 2008 ; 49 : 658-667.〔IVb〕
 
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11) Gurm HS, Dixon SR, Smith DE, Share D, Lalonde T, Greenbaum A, Moscucci M ; BMC2 (Blue Cross Blue Shield of Michigan Cardiovascular Consortium) : Renal function-based contrast dosing to define safe limits of radiographic contrast media in patients undergoing percutaneous coronary interventions. J Am Coll Cardiol 2011 ; 58 : 907-914.〔IVb〕
 
12) Gruberg L, Mintz GS, Mehran R, Gangas G, Lansky AJ, Kent KM, Pichard AD, Satler LF, Leon MB : The prognostic implications of further renal function deterioration within 48h of interventional coronary procedures in patients with pre-existent chronic renal insufficiency. J Am Coll Cardiol 2000 ; 36 : 1542-1548.〔IVa〕
 
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6 非侵襲的診断法 ( 造影CTなど )

P.45 掲載の参考文献
1) Utsunomiya D, Yanaga Y, Awai K, Oda S, Funama Y, Namimoto T, Yamashita Y : Baseline incidence and severity of renal insufficiency evaluated by estimated glomerular filtration rates in patients scheduled for contrast-enhanced CT. Acta Radiol 2011 ; 52 (5) : 581-586.〔IVb〕
 
2) Oleinik A, Romero JM, Schwab K, Lev MH, Jhawar N, Delgado Almandoz JE, Smith EE, Greenberg SM, Rosand J, Goldstein JN : CT angiography for intracerebral hemorrhage does not increase risk of acute nephropathy. Stroke 2009 ; 40 (7) : 2393-2397.〔IVa〕
 
3) Herts BR, Schneider E, Obuchowski N, Poggio E, Jain A, Baker ME : Probability of reduced renal function after contrast-enhanced CT : a model based on serum creatinine level, patient age, and estimated glomerular filtration rate. AJR Am J Roentgenol 2009 ; 193 (2) : 494-500.〔IVb〕
 
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6) Shema L, Ore L, Geron R, Kristal B : Contrast-induced nephropathy among Israeli hospitalized patients : incidence, risk factors, length of stay and mortality. Isr Med Assoc J 2009 ; 11 (8) : 460-464.〔IVb〕
 
7) Becker CR, Reiser MF : Use of iso-osmolar nonionic dimeric contrast media in multidetector row computed tomography angiography for patients with renal impairment. Invest Radiol 2005 ; 40 (10) : 672-675.〔IVa〕
 
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9) Langner S, Stumpe S, Kirsch M, Petrik M : No increased risk for contrast-induced nephropathy after multiple CT perfusion studies of the brain with a nonionic, dimeric, iso-osmolal contrast medium. AJNR Am J Neuroradiol 2008 ; 29 (8) : 1525-1529.〔IVa〕
 
10) Kim SM, Cha RH, Lee JP, Kim DK, Oh KH, Joo KW, Lim CS, Kim S, Kim YS : Incidence and outcomes of contrast-induced nephropathy after computed tomography in patients with CKD : a quality improvement report. Am J Kidney Dis 2010 ; 55 (6) : 1018-1025.〔IVb〕
 
11) Weisbord SD, Mor MK, Resnick AL, Hartwig KC, Palevsky PM, Fine MJ : Incidence and outcomes of contrast-induced AKI following computed tomography. Clin J Am Soc Nephrol 2008 ; 3 (5) : 1274-1281.〔IVa〕
 
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16) Nyman U, Bjork J, Aspelin P, Marenzi G : Contrast medium dose-to-GFR ratio : a measure of systemic exposure to predict contrast-induced nephropathy after percutaneous coronary intervention. Acta Radiol 2008 ; 49 (6) : 658-667. 〔V〕
 
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21) Stacul F, van der Molen AJ, Reimer P, Webb JA, Thomsen HS, Morcos SK, Almen T, Aspelin P, Bellin MF, Clement O, Heinz-Peer G ; Contrast Media Safety Committee of European Society of Urogenital Radiology (ESUR) : Contrast induced nephropathy : updated ESUR Contrast Media Safety Committee guidelines. Eur Radiol 2011 ; 21 : 2527-2541. 〔VI〕
 
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7 造影剤腎症の予防法 : 輸液

P.54 掲載の参考文献
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14) Joannidis M, Schmid M, Wiedermann CJ : Prevention of contrast media-induced nephropathy by isotonic sodium bicarbonate : a meta-analysis. Wien Klin Wochenschr 2008 ; 120 : 742-748.〔I〕
 
15) Navaneethan SD, Singh S, Appasamy S, Wing RE, Sehgal AR : Sodium bicarbonate therapy for prevention of contrast-induced nephropathy : a systematic review and meta-analysis. Am J Kidney Dis 2009 ; 53 : 617-627.〔I〕
 
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19) Ueda H, Yamada T, Masuda M, Okuyama Y, Morita T, Furukawa Y, Koji T, Iwasaki Y, Okada T, Kawasaki M, Kuramoto Y, Naito T, Fujimoto T, Komuro I, Fukunami M : Prevention of contrast-induced nephropathy by bolus injection of sodium bicarbonate in patients with chronic kidney disease undergoing emergent coronary procedures. Am J Cardiol 2011 ; 107 : 1163-1167.〔II〕
 
20) Tamura A, Goto Y, Miyamoto K, Naono S, Kawano Y, Kotoku M, Watanabe T, Kadota J : Efficacy of single-bolus administration of sodium bicarbonate to prevent contrast-induced nephropathy in patients with mild renal insufficiency undergoing an elective coronary procedure. Am J Cardiol 2009 ; 104 : 921-925.〔II〕
 
21) Motohiro M, Kamihata H, Tsujimoto S, Seno T, Manabe K, Isono T, Sutani Y, Yuasa F, Iwasaka T : A new protocol using sodium bicarbonate for the prevention of contrast-induced nephropathy in patients undergoing coronary angiography. Am J Cardiol 2011 ; 107 : 1604-1608.〔II〕
 
22) Lee SW, Kim WJ, Kim YH, Park SW, Park DW, Yun SC, Lee JY, Kang SJ, Lee CW, Lee JH, Choi SW, Seong IW, Suh J, Cho YH, Lee NH, Cheong SS, Yoo SY, Lee BK, Lee SG, Hyon MS, Shin WY, Lee SW, Jang JS, Park SJ : Preventive strategies of renal insufficiency in patients with diabetes undergoing intervention or arteriography (the PREVENT Trial). Am J Cardiol 2011 ; 107 : 1447-1452.〔II〕
 
23) Vasheghani-Farahani A, Sadigh G, Kassaian SE, Khatami SM, Fotouhi A, Razavi SA, Mansournia MA, Yamini-Sharif A, Amirzadegan A, Salarifar M, Sadeghian S, Davoodi G, Borumand MA, Esfehani FA, Darabian S : Sodium bicarbonate plus isotonic saline versus saline for prevention of contrast-induced nephropathy in patients undergoing coronary angiography : a randomized controlled trial. Am J Kidney Dis 2009 ; 54 : 610-618.〔II〕
 
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8 造影剤腎症の予防法 : 薬物療法

P.67 掲載の参考文献
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3) Tepel M, van der Giet M, Schwarzfeld C, Laufer U, Liermann D, Zidek W : Prevention of radiographic-contrast-agent-induced reductions in renal function by acetylcysteine. N Engl J Med 2000 ; 343 : 180-184.〔II〕
 
4) Webb JG, Pate GE, Humphries KH, Buller CE, Shalansky S, Al Shamari A, Sutander A, Williams T, Fox RS, Levin A : A randomized controlled trial of intravenous N-acetylcysteine for the prevention of contrast-induced nephropathy after cardiac catheterization : lack of effect. Am Heart J 2004 ; 148 (3) : 422-429.〔II〕
 
5) Azmus AD, Gottschall C, Manica A, Manica J, Duro K, Frey M, Bulcao L, Lima C : Effectiveness of acetylcysteine in prevention of contrast nephropathy. J Invasive Cardiol 2005 ; 17 (2) : 80-84.〔II〕
 
6) Marenzi G, Assanelli E, Marana I, Lauri G, Campodonico J, Grazi M, De Metrio M, Galli S, Fabbiocchi F, Montorsi P, Veglia F, Bartorelli AL : N-acetylcysteine and contrast-induced nephropathy in primary angioplasty. N Engl J Med 2006 ; 29 ; 354 (26) : 2773-2782.〔II〕
 
7) ACT Investigators : Acetylcysteine for prevention of renal outcomes in patients undergoing coronary and peripheral vascular angiography : main results from the randomized Acetylcysteine for Contrast-induced nephropathy Trial (ACT). Circulation 2011 ; 124 : 1250-1259.〔II〕
 
8) Kelly AM, Dwamena B, Cronin P, Bernstein SJ, Carlos RC : Meta-analysis : effectiveness of drugs for preventing contrast-induced nephropathy. Ann Intern Med 2008 ; 148 : 284-294.〔I〕
 
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9 造影剤腎症の予防法 : 透析

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10 造影剤腎症の治療法

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