Department of Internal Medicine, McLaren Regional Medical Center/Michigan State University, Flint, MI 48202, USA.
J Nucl Cardiol. 2011 Aug;18(4):605-11. doi: 10.1007/s12350-011-9378-8. Epub 2011 May 4.
Pharmacokinetic studies suggest delayed clearance of Regadenoson (REG), a new selective A2A receptor agonist in chronic kidney disease (CKD). The safety of REG in large series of CKD patients in daily clinical practice remains unstudied.
Retrospective study of patients with eGFR < 60 mL/min (n = 411, Grp 1, CKD) were compared to patients with eGFR ≥ 60 mL/min (n = 638, Grp 2, Control) undergoing REG-SPECT from Jan to Nov 2009. Patient demographics, REG-SPECT data, side effects, and arrhythmia occurrences were evaluated.
No major adverse events were noted immediately after REG-SPECT or at 1 week of follow-up. There were no differences in any arrhythmias in between the two groups (Grp 1, 47.2% vs Grp 2, 42.9%, P = ns). Ninety-nine percent of arrhythmias in CKD patients were PACs or PVCs. Transient junctional rhythm was observed in one CKD patient. There were no occurrences of second degree or higher degree AV block. Grp 1 had a blunted heart rate response (16.6 ± 16.1 vs 24.9 ± 20.3 bpm, P ≤ .001) and greater systolic blood pressure drop response (-7.4 ± 21.1 vs -1.4 ± 20.9 mm Hg, P ≤ .001) compared to Grp 2. Transient headache was more in Grp 2 (15.8% vs 22.6%, P ≤ .007). Aminophylline use to ward-off the side effects was comparable (9.5% vs 9.9%, P = ns).
REG-SPECT can be safely performed in CKD non-dialysis patients with excellent tolerability, minimal side effects, and favorable hemodynamic responses compared to control group.
药代动力学研究表明，新型选择性 A2A 受体激动剂雷加登素（REG）在慢性肾脏病（CKD）患者中的清除时间延长。REG 在大量 CKD 患者中的安全性在日常临床实践中尚未得到研究。
回顾性分析 2009 年 1 月至 11 月接受 REG-SPECT 的 eGFR<60mL/min（n=411，Grp 1，CKD）和 eGFR≥60mL/min（n=638，Grp 2，对照组）患者的资料。评估患者人口统计学资料、REG-SPECT 数据、副作用和心律失常发生情况。
REG-SPECT 后即刻或 1 周随访时均未发生重大不良事件。两组之间的任何心律失常均无差异（Grp 1，47.2%比 Grp 2，42.9%，P=ns）。CKD 患者的心律失常 99%为房性期前收缩或室性期前收缩。一名 CKD 患者出现短暂性结性节律。无二度或更高度房室传导阻滞发生。Grp 1 的心率反应更迟钝（16.6±16.1 比 24.9±20.3bpm，P≤.001），收缩压下降反应更明显（-7.4±21.1 比-1.4±20.9mmHg，P≤.001）。Grp 2 组的一过性头痛更多（15.8%比 22.6%，P≤.007）。使用氨茶碱缓解副作用的情况相当（9.5%比 9.9%，P=ns）。
与对照组相比，REG-SPECT 可安全应用于非透析 CKD 患者，具有良好的耐受性、最小的副作用和有利的血液动力学反应。
