Budhiraja Pooja, Chen Zhao, Popovtzer Mordecai
University of Arizona College of Medicine, Tucson, Arizona, USA.
Ren Fail. 2009;31(2):118-23. doi: 10.1080/08860220802599239.
Contrast-induced nephropathy (CIN) is a form of acute kidney injury and a significant source of morbidity and mortality. We defined CIN as an increase in serum creatinine (SCr) of 25% or more within 48 hours of receiving contrast. We retrospectively compared sodium bicarbonate with normal saline for prevention of CIN. One hundred and eighty-seven patients exposed to contrast during cardiac angiography, treated prophylactically either with sodium bicarbonate (n = 89) or with normal saline (n = 98), were studied. Baseline characteristics of both groups were similar in terms of age, amount of contrast, presence of diabetes mellitus, and use of furosemide and angiotensin-converting enzyme inhibitor. Patients in bicarbonate group had more severe renal disease with higher baseline SCr (1.58 +/- 0.5 mg/dL vs. 1.28 +/- 0.3 mg/dL, p = 0.001) and lower estimated glomerular filtration rate (eGFR, 51.06 +/- 14.0 mL/min vs. 62.3+/-13.5 mL/min, p = 0.001) compared to the normal saline group. After the contrast exposure, there was significant drop in eGFR (6.4%) and increase in SCr (11.3%) in the normal saline group and no significant change in the bicarbonate group. Three patients (3.4%) in the bicarbonate group as opposed to 14 patients (14.3%) in the normal saline group developed CIN (p = 0.011). Two patients in the normal saline group and none in the bicarbonate group needed dialysis. There was no significant difference in serum creatinine at three-month follow-up in either group. The above findings suggest that hydration with intravenous sodium bicarbonate is more effective than normal saline in preventing contrast-induced nephropathy.
对比剂肾病（CIN）是急性肾损伤的一种形式，也是发病和死亡的重要原因。我们将CIN定义为在接受对比剂后48小时内血清肌酐（SCr）升高25%或更多。我们回顾性比较了碳酸氢钠与生理盐水预防CIN的效果。对187例在心脏血管造影期间接受对比剂的患者进行了研究，这些患者预防性地接受了碳酸氢钠治疗（n = 89）或生理盐水治疗（n = 98）。两组患者在年龄、对比剂用量、糖尿病的存在以及呋塞米和血管紧张素转换酶抑制剂的使用方面基线特征相似。与生理盐水组相比，碳酸氢钠组患者的肾病更严重，基线SCr更高（1.58±0.5mg/dL对1.28±0.3mg/dL，p = 0.001），估计肾小球滤过率（eGFR）更低（51.06±14.0mL/min对62.3±13.5mL/min，p = 0.001）。对比剂暴露后，生理盐水组的eGFR显著下降（6.4%），SCr升高（11.3%），而碳酸氢钠组无显著变化。碳酸氢钠组有3例患者（3.4%）发生CIN，而生理盐水组有14例患者（14.3%）发生CIN（p = 0.011）。生理盐水组有2例患者需要透析，碳酸氢钠组无患者需要透析。两组在三个月随访时血清肌酐无显著差异。上述结果表明，静脉输注碳酸氢钠进行水化治疗在预防对比剂肾病方面比生理盐水更有效。
