Agarwal Shiv Kumar, Mohareb Sameh, Patel Achint, Yacoub Rabi, DiNicolantonio James J, Konstantinidis Ioannis, Pathak Ambarish, Fnu Shailesh, Annapureddy Narender, Simoes Priya K, Kamat Sunil, El-Hayek Georges, Prasad Ravi, Kumbala Damodar, Nascimento Rhanderson M, Reilly John P, Nadkarni Girish N, Benjo Alexandre M
Division of Cardiovascular Diseases, Department of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas , USA.
Division of Cardiology, Department of Internal Medicine , Ochsner Clinic Foundation , New Orleans, Louisiana , USA.
Open Heart. 2015 Oct 5;2(1):e000317. doi: 10.1136/openhrt-2015-000317. eCollection 2015.
Contrast-induced nephropathy (CIN) is the third most common cause of hospital-acquired kidney injury and is related to increased long-term morbidity and mortality. Adequate intravenous (IV) hydration has been demonstrated to lessen its occurrence. Oral (PO) hydration with water is inexpensive and readily available but its role for CIN prevention is yet to be determined.
PubMed, EMBASE and the Cochrane Central register of controlled trials (CENTRAL) databases were searched until April 2015 and studies were selected using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. All randomised clinical trials with head-to-head comparison between PO and IV hydration were included.
A total of 5 studies with 477 patients were included in the analysis, 255 of those receiving PO water. The incidence of CIN was statistically similar in the IV and PO arms (7.7% and 8.2%, respectively; relative risk 0.97; 95% CI 0.36 to 2.94; p=0.95). The incidence of CIN was statistically similar in the IV and PO arms in patients with chronic kidney disease and with normal renal function. Rise in creatinine at 48-72 h was lower in the PO hydration group compared with IV hydration (pooled standard mean difference 0.04; 95% CI 0.03 to 0.06; p<0.001; I(2)=62%).
Our meta-analysis shows that systematic PO hydration with water is at least as effective as IV hydration with saline to prevent CIN. PO hydration is cheaper and more easily administered than IV hydration, thus making it more attractive and just as effective.
对比剂肾病（CIN）是医院获得性肾损伤的第三大常见原因，与长期发病率和死亡率增加相关。充分的静脉补液已被证明可减少其发生。口服（PO）水补液价格低廉且易于获得，但其在预防CIN中的作用尚未确定。
检索截至2015年4月的PubMed、EMBASE和Cochrane对照试验中央注册库（CENTRAL）数据库，并使用系统评价和Meta分析的首选报告项目（PRISMA）清单选择研究。纳入所有PO补液与静脉补液进行直接比较的随机临床试验。
分析共纳入5项研究477例患者，其中255例接受PO水补液。静脉补液组和PO补液组CIN的发生率在统计学上相似（分别为7.7%和8.2%；相对危险度0.97；95%可信区间0.36至2.94；p=0.95）。慢性肾脏病患者和肾功能正常患者的静脉补液组和PO补液组CIN发生率在统计学上相似。与静脉补液相比，PO补液组48 - 72小时肌酐升高更低（合并标准平均差0.04；95%可信区间0.03至0.06；p<0.001；I²=62%）。
我们的Meta分析表明，系统性口服水补液预防CIN至少与静脉输注生理盐水补液一样有效。PO补液比静脉补液更便宜且更易于实施，因此更具吸引力且同样有效。
