慢性腎不全患者における心血管造影検査後の非イオン性ヨード造影剤の薬物動態　　血中および尿中濃度からの検討

DOI 被引用文献1件 参考文献16件
  • 君川 正昭
    東京女子医科大学腎臓病総合医療センター外科
  • 岡部 正明
    立川メディカルセンター立川綜合病院循環器内科
  • 青柳 竜治
    立川メディカルセンター立川綜合病院腎臓内科
  • 小幡 紀夫
    立川メディカルセンター立川綜合病院中越診療所
  • 寺岡 慧
    東京女子医科大学腎臓病総合医療センター外科

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タイトル別名
  • The pharmacokinetics of nonionic iodinated contrast medium after cardiac angiography in patients with chronic renal failure.

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Radiological examinations using contrast medium are routinely performed in patients with renal insufficiency. Since intravascularly administered contrast medium is retained in patients with renal dysfunction, prophylactic hemodialysis has been indicated routinely immediately after examination in all patients with renal insufficiency.<br>In the present study, we examined the pharmacokinetics of contrast medium elimination during hemodialysis after cardiac angiography. The subjects were 8 patients with end-stage renal disease on regular hemodialysis and 4 patients with impaired renal function. In both groups, contrast medium was eventually eliminated over time. The mean removal rate of iodine present in the circulation at the start of dialysis was 44.6% after one hour, 60.5% after two hours, 71.4% after three hours and 85.1% at the end of dialysis. Mean iodine clearance at 15 min and 30 min was 110mL/min and 113mL/min, respectively.<br>In patients with impaired renal function, who were not dialyzed regularly, we examined urine iodine concentration in addition to blood iodine concentration. Urine iodine concentration was higher than blood iodine concentration. High urine iodine concentration was evident for a long time, and was even detected the following morning. Blood iodine concentration after radiological examination showed a strong correlation (r=0.82, p<0.001) with the volume of contrast medium per body weight (mL/kg), facilitating prediction of blood iodine concentration by calculation. This process has the potential to assist decision-making on whether to carry out dialysis to eliminate contrast medium after radiological examination.<br>Hemodialysis proved to be an effective method for removing iodine. Since high concentrations of iodine were detected in the urine of patients with impaired renal function, dialysis and sufficient per oral or intravenous fluids should be routinely prescribed before and for a few days after radiocontrast procedure in order to ensure a high urine output.

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