Dussol Bertrand, Morange Sophie, Loundoun Anderson, Auquier Pascal, Berland Yvon
Service de Néphrologie-Hémodialyse-Transplantation rénale, Hôpital de la Conception, 147 Bd Baille, 13385 Marseille Cedex 5, France.
Nephrol Dial Transplant. 2006 Aug;21(8):2120-6. doi: 10.1093/ndt/gfl133. Epub 2006 Apr 12.
Contrast nephropathy (CN) is a common cause of renal dysfunction that may be prevented by saline hydration and by drugs such as theophylline or furosemide. Whether oral saline hydration is as efficient as intravenous saline hydration is unknown. The preventive efficacy of theophylline and furosemide for CN remains controversial. The purpose of the current study was to evaluate the efficacy of oral saline hydration and of intravenous saline hydration plus theophylline or furosemide for the prevention of CN.
We prospectively studied 312 patients with chronic renal failure (serum creatinine 201+/-81 micromol/l, Cockcroft clearance 37+/-12 ml/min/1.73 m(2)), who were undergoing various radiological procedures with a non-ionic, low osmolality contrast agent. Patients were randomly assigned to four arms. In arm A, patients received 1 g/10 kg of body weight/day of sodium chloride per os for 2 days before the procedure. In arm B, patients received 0.9% saline intravenously at a rate of 15 ml/kg for 6 h before the procedure. In arm C, patients received the same saline hydration as in arm B plus 5 mg/kg theophylline per os in one dose 1 h before the procedure. In arm D, patients received the same saline hydration as in arm B plus 3 mg/kg of furosemide intravenously just after the procedure.
Patients were well-matched with no significant differences at baseline in any measured parameters. Acute renal failure, defined as an increase in serum creatinine of 44 micromol/l (0.5 mg/dl), occurred in 27 out of 312 patients (8.7%). There was no significant difference between the rate of renal failure in the different arms of the study: five out of 76 (6.6%) in arm A, four out of 77 (5.2%) in arm B, six out of 80 (7.5%) in arm C and 12 out of 79 (15.2%) in arm D. No patient had fluid overload or a significant increase in blood pressure in the 2 days following the radiological procedure. The independent predictors of CN were diabetes mellitus, high baseline serum creatinine and high systolic blood pressure.
Oral saline hydration was as efficient as intravenous saline hydration for the prevention of CN in patients with stage 3 renal diseases. Furosemide and theophylline were not protective.
对比剂肾病（CN）是肾功能不全的常见原因，可通过生理盐水水化以及使用氨茶碱或呋塞米等药物预防。口服生理盐水水化是否与静脉生理盐水水化一样有效尚不清楚。氨茶碱和呋塞米对CN的预防效果仍存在争议。本研究的目的是评估口服生理盐水水化以及静脉生理盐水水化联合氨茶碱或呋塞米预防CN的效果。
我们前瞻性研究了312例慢性肾衰竭患者（血清肌酐201±81 μmol/L，Cockcroft肌酐清除率37±12 ml/min/1.73 m²），这些患者正在接受使用非离子型、低渗性对比剂的各种放射学检查。患者被随机分为四组。A组患者在检查前2天口服1 g/10 kg体重/天的氯化钠。B组患者在检查前6小时以15 ml/kg的速率静脉输注0.9%生理盐水。C组患者接受与B组相同的生理盐水水化，并在检查前1小时口服5 mg/kg氨茶碱一剂。D组患者接受与B组相同的生理盐水水化，并在检查后立即静脉注射3 mg/kg呋塞米。
患者基线时各测量参数匹配良好，无显著差异。定义为血清肌酐升高44 μmol/L（0.5 mg/dl）的急性肾衰竭在312例患者中有27例（8.7%）发生。研究不同组间肾衰竭发生率无显著差异：A组76例中有5例（6.6%），B组77例中有4例（5.2%），C组80例中有6例（7.5%），D组79例中有12例（15.2%）。放射学检查后2天内无患者出现液体超负荷或血压显著升高。CN的独立预测因素为糖尿病、高基线血清肌酐和高收缩压。
对于3期肾病患者，口服生理盐水水化在预防CN方面与静脉生理盐水水化一样有效。呋塞米和氨茶碱无保护作用。
