Pakfetrat Maryam, Nikoo Mohammad Hossein, Malekmakan Leila, Tabandeh Mahmood, Roozbeh Jamshid, Nasab Mahshid Hashemi, Ostovan Mohammad Ali, Salari Soheila, Kafi Mohammad, Vaziri Najmeh Moin, Adl Farzad, Hosseini Mehdi, Khajehdehi Parviz
Shiraz Nephro-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
Int Urol Nephrol. 2009;41(3):629-34. doi: 10.1007/s11255-008-9520-y. Epub 2009 Jan 10.
Contrast-induced nephropathy (CIN) is commonly encountered. Because the therapy of choice for prevention of CIN is controversial, in this study we compared the preventive efficacy of bicarbonate (Bi) infusion in dextrose water versus normal saline (NLS) infusion alone or in combination with oral acetazolamide (AZ).
In a double-blind and randomized clinical trial, all patients undergoing coronary angiography or percutaneous coronary intervention received NLS (NLS group), its combination with AZ (AZ group) or infusion of Bi (Bi group) before the procedures. RIFLE (risk of renal failure, injury to the kidney, failure of kidney function, loss of kidney function, and end-stage renal disease) criteria were used to define CIN-associated acute kidney injury (AKI).
The risk of AKI in CIN was significantly lower in the Bi and AZ groups than in the NLS group (P <or= 0.04). Comparing pre-treatment and post-treatment values in each group the following results were obtained: serum creatinine (Scr) increased and eGFR decreased significantly in the NLS group (P = 0.04) and in all patients (P = 0.001, P = 0.02, respectively). In addition, serum potassium decreased significantly in the Bi and NLS groups (P <or= 0.02). Also, serum Bi increased significantly in the Bi group (P = 0.001) whereas it decreased significantly in the AZ group (P = 0.001). Urinary pH also increased in all groups (P <or= 0.04) except the NLS group (P > 0.05).
It seems that both Bi and AZ reduce the risk of CIN-related AKI, and close monitoring of serum potassium is needed during bicarbonate infusion.
造影剂肾病（CIN）很常见。由于预防CIN的首选治疗方法存在争议，在本研究中，我们比较了在葡萄糖溶液中输注碳酸氢盐（Bi）与单独输注生理盐水（NLS）或联合口服乙酰唑胺（AZ）的预防效果。
在一项双盲随机临床试验中，所有接受冠状动脉造影或经皮冠状动脉介入治疗的患者在手术前接受NLS（NLS组）、其与AZ联合使用（AZ组）或Bi输注（Bi组）。采用RIFLE（肾衰竭、肾损伤、肾功能衰竭、肾功能丧失和终末期肾病风险）标准来定义与CIN相关的急性肾损伤（AKI）。
Bi组和AZ组CIN中AKI的风险显著低于NLS组（P≤0.04）。比较每组治疗前和治疗后的数值，得到以下结果：NLS组血清肌酐（Scr）显著升高，估算肾小球滤过率（eGFR）显著降低（P = 0.04），在所有患者中Scr和eGFR也分别显著升高和降低（P = 0.001，P = 0.02）。此外，Bi组和NLS组血清钾显著降低（P≤0.02）。而且，Bi组血清Bi显著升高（P = 0.001），而AZ组血清Bi显著降低（P = 0.001）。除NLS组外（P>0.05），所有组的尿液pH值也均升高（P≤0.04）。
似乎Bi和AZ均可降低与CIN相关的AKI风险，在输注碳酸氢盐期间需要密切监测血清钾。
