Ratcliffe Justin A, Thiagarajah Prashan, Chen Jennifer, Kavala Gita, Kanei Yumiko, Fox John, Gowda Ramesh, Schmitz Sabrina J, Friedmann Patricia, Bergmann Steven
Department of Medicine;
Int J Angiol. 2009 Winter;18(4):193-7. doi: 10.1055/s-0031-1278353.
Contrast-induced nephropathy (CIN) continues to be a common cause of acute renal failure in high-risk patients undergoing radiocontrast studies. However, there is still a lack of consensus regarding the most effective measures to prevent CIN.
ONE HUNDRED EIGHTEEN PATIENTS WITH DIABETES MELLITUS AND/OR RENAL INSUFFICIENCY, SCHEDULED FOR CORONARY ANGIOGRAPHY OR INTERVENTION, WERE RANDOMLY ASSIGNED TO ONE OF FOUR TREATMENT GROUPS: intravenous (IV) 0.9% NaCl alone, IV 0.9% NaCl plus N-acetylcysteine (NAC), IV 0.9% sodium bicarbonate (NaHCO(3)) alone or IV 0.9% NaHCO(3) plus NAC. All patients received IV hydration as a preprocedure bolus and as maintenance. Iso-osmolar contrast was used in all patients. CIN was defined as an increase of greater than 25% in the serum creatinine concentration from baseline to 72 h.
The overall incidence of CIN was 6%. There was no statistically significant difference in the incidence of CIN among the groups. There was a CIN incidence of 7% in the NaCl only group, 5% in the NaCl/NAC group, 11% in the NaHCO(3) only group and 4% in the NaHCO(3)/NAC group (P=0.86). The maximum increase in serum creatinine was 14.14±12.38 μmol/L in the NaHCO(3) group, 10.60±29.14 μmol/L in the NaCl only group, 9.72±13.26 μmol/L in the NaCl/NAC group and 0.177±15.91 μmol/L for the NaHCO(3)/NAC group (P=0.0792).
CIN in high-risk patients may be effectively minimized solely through the use of an aggressive hydration protocol and an iso-osmolar contrast agent. The addition of NaHCO(3) and/or NAC did not have an effect on the incidence of CIN.
在接受放射造影检查的高危患者中，对比剂肾病（CIN）仍然是急性肾衰竭的常见原因。然而，对于预防CIN的最有效措施仍缺乏共识。
118例患有糖尿病和/或肾功能不全、计划进行冠状动脉造影或介入治疗的患者被随机分配到四个治疗组之一：单纯静脉注射（IV）0.9%氯化钠、IV 0.9%氯化钠加N-乙酰半胱氨酸（NAC）、单纯IV 0.9%碳酸氢钠（NaHCO₃）或IV 0.9% NaHCO₃加NAC。所有患者在术前接受静脉补液推注并维持补液。所有患者均使用等渗造影剂。CIN定义为血清肌酐浓度从基线到72小时升高超过25%。
CIN的总体发生率为6%。各组之间CIN的发生率无统计学显著差异。单纯氯化钠组CIN发生率为7%，氯化钠/NAC组为5%，单纯碳酸氢钠组为11%，碳酸氢钠/NAC组为4%（P = 0.86）。碳酸氢钠组血清肌酐的最大升高为14.14±12.38μmol/L，单纯氯化钠组为10.60±29.14μmol/L，氯化钠/NAC组为9.72±13.26μmol/L，碳酸氢钠/NAC组为0.177±15.91μmol/L（P = 0.0792）。
高危患者中的CIN可能仅通过积极的补液方案和等渗造影剂的使用就能有效降至最低。添加NaHCO₃和/或NAC对CIN的发生率没有影响。
