Guo Xiao-Sheng, Wu Deng-Xuan, Bei Wei-Jie, Li Hua-Long, Wang Kun, Zhou Ying-Ling, Duan Chong-Yang, Chen Shi-Qun, Lian Dan, Li Li-Wen, Liu Yong, Tan Ning, Chen Ji-Yan
1 Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China.
2 Department of Cardiology, Panzhihua Central Hospital, China.
J Renin Angiotensin Aldosterone Syst. 2017 Apr-Jun;18(2):1470320317708894. doi: 10.1177/1470320317708894.
This study evaluated the potential effect of hydration intensity on the role of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) on contrast-induced nephropathy in patients with renal insufficiency.
All eligible patients were included and stratified according to hydration intensity defined as saline hydration volume to body weight tertiles: <10.21 mL/kg, 10.21 to <17.86 mL/kg, and ⩾17.86 mL/kg.
In total, 84 (6.7%) of 1254 patients developed contrast-induced nephropathy: 6.2% in the ACEI/ARB group versus 10.8% in the non-ACEI/ARB group ( P=0.029), with an adjusted odds ratio (OR) of 0.89 (95% confidence interval (CI) 0.46-1.73, P=0.735). The incidence of contrast-induced nephropathy was lower in the ACEI/ARB group than in the non-ACEI/ARB group in the second tertile ( P=0.031), while not significantly different in the first ( P=0.701) and third ( P=0.254) tertiles. ACEIs/ARBs were independently associated with a lower contrast-induced nephropathy risk (OR 0.26, 95% CI 0.09-0.74, P=0.012) and long-term all-cause death (hazard ratio 0.461, 95% CI 0.282-0.755, P=0.002) only in the second hydration volume to body weight tertile.
The effects of ACEIs/ARBs on contrast-induced nephropathy risk vary according to saline hydration intensity in chronic kidney disease patients, and may further reduce contrast-induced nephropathy risk in patients administered moderate saline hydration.
本研究评估了水化强度对血管紧张素转换酶抑制剂（ACEIs）或血管紧张素受体阻滞剂（ARBs）在肾功能不全患者中预防对比剂肾病作用的潜在影响。
纳入所有符合条件的患者，并根据水化强度进行分层，水化强度定义为生理盐水水化量与体重三分位数之比：<10.21 mL/kg、10.21至<17.86 mL/kg以及⩾17.86 mL/kg。
1254例患者中共有84例（6.7%）发生对比剂肾病：ACEI/ARB组为6.2%，非ACEI/ARB组为10.8%（P = 0.029），校正比值比（OR）为0.89（95%置信区间（CI）0.46 - 1.73，P = 0.735）。在第二个三分位数中，ACEI/ARB组对比剂肾病的发生率低于非ACEI/ARB组（P = 0.031），而在第一个（P = 0.701）和第三个（P = 0.254）三分位数中无显著差异。仅在第二个生理盐水水化量与体重三分位数中，ACEIs/ARBs与较低的对比剂肾病风险（OR 0.26，95% CI 0.09 - 0.74，P = 0.012）和长期全因死亡（风险比0.461，95% CI 0.282 - 0.755，P = 0.002）独立相关。
ACEIs/ARBs对对比剂肾病风险的影响因慢性肾脏病患者的生理盐水水化强度而异，在接受中度生理盐水水化的患者中可能进一步降低对比剂肾病风险。
