Jiang Yufeng, Chen Min, Zhang Yiqing, Zhang Nannan, Yang Huajia, Yao Jialu, Zhou Yafeng
aDepartment of Cardiology, the First Affiliated Hospital of Soochow University bDepartment of Cardiology, Suzhou Municipal Hospital Affiliated to Nanjing Medical University, Suzhou City, Jiangsu Province, People's Republic of China.
Coron Artery Dis. 2017 Dec;28(8):649-657. doi: 10.1097/MCA.0000000000000514.
Guidelines recommend prophylactic hydration for all patients with compromised renal function undergoing contrast exposure. However, the AMACING study published recently showed a noninferior result of hydration compared with no prophylaxis in high-risk patients and led to a heat discussion. This study aimed to validate the effectiveness of prophylactic hydration in different subsets of patients undergoing a contrast procedure.
We carried out a meta-analysis of randomized-controlled trials to assess pooled estimates of relative risk (RR) and 95% confidence intervals (CIs) for incidences of contrast-induced acute kidney injury (CI-AKI), in-hospital all-cause mortality, and need for dialysis.
Compared with no prophylaxis, patients receiving prophylactic hydration had a lower risk of CI-AKI [RR: 0.66 (95% CI: 0.55-0.79); P≤0.001; Pheterogeneity=0.42] and a lower risk of deaths of all-cause [RR: 0.57 (95% CI: 0.33-0.98); P=0.04; Pheterogeneity=0.47], but did not have a decreased risk of need for dialysis [RR: 0.39 (95% CI: 0.12-1.23); P=0.11; Pheterogeneity=0.31]. In subgroup analyses on the incidence of CI-AKI by baseline estimated glomerular filtration rate (eGFR), no benefit from prophylactic hydration was indicated in patients with a baseline eGFR ranging from 30 to 60 ml/min/1.73 m [RR: 1.02 (95% CI: 0.66-1.60); Pheterogeneity=0.66; Pinteraction=0.03].
Our analysis indicated that prophylactic hydration was associated with a lower risk of CI-AKI and all-cause deaths, but not with the need for dialysis in the overall population. However, no prophylactic hydration is noninferior to intravenous hydration on the incidence of CI-AKI in patients with a baseline eGFR ranging from 30 to 60 ml/min/1.73 m.
指南建议对所有接受造影剂的肾功能受损患者进行预防性水化治疗。然而，最近发表的AMACING研究显示，在高危患者中，水化治疗与不进行预防相比，结果并无劣势，这引发了激烈的讨论。本研究旨在验证预防性水化治疗在接受造影剂检查的不同亚组患者中的有效性。
我们对随机对照试验进行了荟萃分析，以评估对比剂诱导的急性肾损伤（CI-AKI）发生率、院内全因死亡率和透析需求的相对风险（RR）合并估计值及95%置信区间（CI）。
与不进行预防相比，接受预防性水化治疗的患者发生CI-AKI的风险较低[RR：0.66（95%CI：0.55-0.79）；P≤0.001；P异质性=0.42]，全因死亡风险较低[RR：0.57（95%CI：0.33-0.98）；P=0.04；P异质性=0.47]，但透析需求风险并未降低[RR：0.39（95%CI：0.12-1.23）；P=0.11；P异质性=0.31]。在根据基线估计肾小球滤过率（eGFR）对CI-AKI发生率进行的亚组分析中，基线eGFR为30至60ml/min/1.73m的患者未显示预防性水化治疗有任何益处[RR：1.02（95%CI：0.66-1.60）；P异质性=0.66；P交互作用=0.03]。
我们的分析表明，预防性水化治疗与较低的CI-AKI风险和全因死亡风险相关，但与总体人群的透析需求无关。然而，对于基线eGFR为30至60ml/min/1.73m的患者，不进行预防性水化治疗在CI-AKI发生率方面并不劣于静脉水化治疗。
