p.36 抽出テキスト

近年,Cheungpasitporn らは,腎移植レシピエント患者を対象としたCIN 発症のメタ解析を報告した65).移植後早期(1~2 カ月以内)に造影剤を使用した研究を除いた6 つの臨床研究の検討(431 症例)では,CIN 発症率は9.6%(冠動脈造影;16.1%,血管造影;10.1%,造影CT; 6.1%)であった.しかし,この検討では,レシピエント患者のCIN 発症率を記述的に検討したのみであり,両腎患者との比較はされていない. McDonald らは,単施設で造影CT を受けた6,175 例を後ろ向きに検討している66).ベースの腎機能や基礎疾患などを調節するためにpropensity score(1:3)matching を実施し,片腎247例と両腎691 例を比較した.片腎は悪性腫瘍による腎摘;76%,移植レシピエント;5%,その他;19%で腎摘出後30 日以降に造影CT が実施されている.その結果,造影CT 後のCIN 発症はそれぞれ4.1%,4.2%(単腎のOR 0.96(0.41~2.07))と有意な差は認められなかった.ただし,この検討においてeGFR>60 mL/min/1.73 m2が47%を占め,eGFR 30~59 mL/min/ 1.73m2が52%,eGFR<30 mL/min/1.73 m2は0.4%であり,eGFR<30 mL/min/1.73 m2 の患者におけるリスクは不明である.十分なエビデンスが不足しており,現時点で片腎がCIN のリスク因子となる根拠は明らかではない.今後のさらなる検討が必要である.

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