Lee Po-Tsang, Chou Kang-Ju, Liu Chun-Peng, Mar Guang-Yuan, Chen Chien-Liang, Hsu Chih-Yang, Fang Hua-Chang, Chung Hsiao-Min
Division of Nephrology, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
J Am Coll Cardiol. 2007 Sep 11;50(11):1015-20. doi: 10.1016/j.jacc.2007.05.033. Epub 2007 Aug 24.
We performed a study to determine whether prophylactic hemodialysis reduces contrast nephropathy (CN) after coronary angiography in advanced renal failure patients.
Pre-existing renal failure is the greatest risk factor for CN. Hemodialysis can effectively remove contrast media, but its effect upon preventing CN is still uncertain.
Eighty-two patients with chronic renal failure, referred for coronary angiography, were assigned randomly to receive either normal saline intravenously and prophylactic hemodialysis (dialysis group; n = 42) or fluid supplement only (control group; n = 40).
Prophylactic hemodialysis lessened the decrease in creatinine clearance within 72 h in the dialysis group (0.4 +/- 0.9 ml/min/1.73 m(2) vs. 2.2 +/- 2.8 ml/min/1.73 m(2); p < 0.001). Compared with the dialysis group, the serum creatinine concentrations in the control group were significantly higher at day 4 (6.3 +/- 2.3 mg/dl vs. 5.1 +/- 1.3 mg/dl; p = 0.010) and at peak level (6.7 +/- 2.7 mg/dl vs. 5.3 +/- 1.5 mg/dl; p = 0.005). Temporary renal replacement therapy was required in 35% of the control patients and in 2% of the dialysis group (p < 0.001). Thirteen percent of the control patients, but none of the dialysis patients, required long-term dialysis after discharge (p = 0.018). For the patients not requiring chronic dialysis, 13 patients in the control group (37%) and 2 in the dialysis group (5%) had an increase in serum creatinine concentration at discharge of more than 1 mg/dl from baseline (p < 0.001).
Prophylactic hemodialysis is effective in improving renal outcome in chronic renal failure patients undergoing coronary angiography.
我们开展了一项研究，以确定预防性血液透析能否降低晚期肾衰竭患者冠状动脉造影术后的造影剂肾病（CN）。
既往存在的肾衰竭是发生CN的最大危险因素。血液透析可有效清除造影剂，但其对预防CN的效果仍不确定。
82例因冠状动脉造影而转诊的慢性肾衰竭患者被随机分配，分别接受静脉注射生理盐水及预防性血液透析（透析组；n = 42）或仅接受补液治疗（对照组；n = 40）。
预防性血液透析减轻了透析组72小时内肌酐清除率的下降（0.4±0.9 ml/min/1.73 m² 对比2.2±2.8 ml/min/1.73 m²；p < 0.001）。与透析组相比，对照组在第4天（6.3±2.3 mg/dl对比5.1±1.3 mg/dl；p = 0.010）及峰值水平时（6.7±2.7 mg/dl对比5.3±1.5 mg/dl；p = 0.005）的血清肌酐浓度显著更高。35%的对照组患者及2%的透析组患者需要临时肾脏替代治疗（p < 0.001）。13%的对照组患者出院后需要长期透析，但透析组患者均无此情况（p = 0.018）。对于不需要长期透析的患者，对照组有13例患者（37%）出院时血清肌酐浓度较基线升高超过1 mg/dl，而透析组仅有2例患者（5%）出现这种情况（p < 0.001）。
预防性血液透析对于改善接受冠状动脉造影的慢性肾衰竭患者的肾脏结局有效。
