Adolph Esther, Holdt-Lehmann Birgit, Chatterjee Tushar, Paschka Susanne, Prott Andreas, Schneider Henrik, Koerber Thomas, Ince Hüseyin, Steiner Michael, Schuff-Werner Peter, Nienaber Christoph A
Division of Cardiology, Department of Internal Medicine, University of Rostock, Germany.
Coron Artery Dis. 2008 Sep;19(6):413-9. doi: 10.1097/MCA.0b013e3283021ac6.
For the prevention of contrast-induced nephropathy (CIN) after coronary angiography, hydration by 0.9% sodium chloride solution and N-acetylcysteine is currently recommended. However, it is unclear whether volume supplementation with sodium bicarbonate is better than with sodium chloride when used in conjunction with nonionic, low-osmolar iopamidol. The aim of this study was to analyze and compare the effects of sodium bicarbonate and sodium chloride on renal function in 145 patients exposed to nonionic iso-osmolar contrast medium iodixanol in a randomized study.
Renal Insufficiency Following Radiocontrast Exposure is a prospective, randomized, single-center, double-blinded trial of 145 patients (age 72.6+/-6.7 years) with elevated baseline serum creatinine levels (mean 132.6+/-29.3 micromol/l). Eligible patients were randomized to either a 154 mEq/l infusion of sodium bicarbonate (n=71, group I) or sodium chloride 0.9% solution (n=74, group II). The primary endpoint was serum creatinine elevation beyond 25% or 44 micromol/l on the first or second day following exposure to the contrast medium. Serum creatinine, serum cystatin C, plasma viscosity, urinary enzymes alanine aminopeptidase and N-acetyl-beta-D-glucosaminidase, and alpha1-microglobulin were measured at baseline and on days 1 and 2 after contrast medium administration.
An overall proportion of five CIN (3.4%) was observed with equal distribution among the groups (4.2% in sodium bicarbonate group vs. 2.7% in sodium chloride group; P=0.614). Parameters of renal function demonstrated no differences between the two hydration regimens on day 1 after angiography; even on day 2 most parameters were similar in groups I and II.
Renal Insufficiency Following Radiocontrast Exposure demonstrates a homogeneously low rate of CIN after exposure to nonionic, iso-osmolar iodixanol regardless of the use of either bicarbonate sodium or sodium chloride solution for volume supplementation. Low-toxicity contrast media and any hydration may offset potential antioxidant effects of sodium bicarbonate.
目前推荐使用0.9%氯化钠溶液和N-乙酰半胱氨酸进行水化，以预防冠状动脉造影后对比剂肾病（CIN）。然而，当与非离子型、低渗性碘帕醇联合使用时，补充碳酸氢钠是否比补充氯化钠在增加血容量方面效果更好尚不清楚。本研究旨在通过一项随机研究分析和比较碳酸氢钠和氯化钠对145例接受非离子等渗对比剂碘克沙醇的患者肾功能的影响。
放射性对比剂暴露后肾功能不全研究是一项前瞻性、随机、单中心、双盲试验，纳入145例患者（年龄72.6±6.7岁），其基线血清肌酐水平升高（平均132.6±29.3μmol/L）。符合条件的患者被随机分为两组，分别接受154 mEq/L的碳酸氢钠输注（n = 71，I组）或0.9%氯化钠溶液输注（n = 74，II组）。主要终点是在接触对比剂后的第一天或第二天血清肌酐升高超过25%或44μmol/L。在基线以及对比剂给药后第1天和第2天测量血清肌酐、血清胱抑素C、血浆粘度、尿酶丙氨酸氨基肽酶和N-乙酰-β-D-氨基葡萄糖苷酶以及α1-微球蛋白。
共观察到5例CIN（3.4%），两组分布相同（碳酸氢钠组为4.2%，氯化钠组为2.7%；P = 0.614）。血管造影后第1天，两种水化方案在肾功能参数方面无差异；甚至在第2天，I组和II组的大多数参数仍相似。
放射性对比剂暴露后肾功能不全研究表明，无论使用碳酸氢钠还是氯化钠溶液进行容量补充，在接触非离子等渗碘克沙醇后CIN发生率均较低且均匀。低毒性对比剂和任何水化措施可能抵消了碳酸氢钠的潜在抗氧化作用。
