Division of Cardiology, Santo Stefano Hospital, Prato, Italy.
Division of Cardiology, Santo Stefano Hospital, Prato, Italy.
J Am Coll Cardiol. 2018 Jun 26;71(25):2880-2889. doi: 10.1016/j.jacc.2018.04.022.
Intravascular volume expansion plays a major role in the prevention of contrast-induced acute kidney injury (CI-AKI). Recommended standard amounts of fluid infusion before procedures do not produce homogeneous responses in subjects with different initial hydration status.
The goal of this study was to compare the effect of standard and double intravenous (IV) infusion volumes in patients with low body fluid level, assessed by using bioimpedance vector analysis (BIVA), on the incidence of CI-AKI after elective coronary angiographic procedures.
A total of 303 patients with low BIVA level on admission were randomized to receive standard volume saline (1 ml/kg/h for 12 h before and after the procedure) or double volume saline (2 ml/kg/h). Patients (n = 715) with an optimal BIVA level received standard volume saline and were included in a prospective registry. The saline infusion was halved in all patients with an ejection fraction <40%. BIVA was repeated immediately before the angiographic procedure in all patients. CI-AKI was defined as an increase in levels of cystatin C ≥10% above baseline at 24 h after contrast administration.
The incidence of CI-AKI was significantly lower (11.5% vs. 22.3%; p = 0.015) in patients receiving double volume saline than in those receiving standard volume saline, respectively. Before the angiographic procedure, 50% of the double volume patients achieved the optimal BIVA level compared with only 27.7% in the standard group (p = 0.0001). The findings were consistent in all the pre-specified subgroups excluding patients with a left ventricular ejection fraction <40% (p for interaction = 0.01).
Evaluation of BIVA levels on admission in patients with stable coronary artery disease allows adjustment of intravascular volume expansion, resulting in lower CI-AKI occurrence after angiographic procedures. (Personalized Versus Standard Hydration for Prevention of CI-AKI: A Randomized Trial With Bioimpedance Analysis; NCT02225431).
血管内容量扩张在预防对比剂诱导的急性肾损伤（CI-AKI）中起着重要作用。在进行介入前推荐的标准液体输注量并不能使不同初始水化状态的患者产生均匀的反应。
本研究的目的是比较低血容量患者接受标准和双倍静脉（IV）输注量对择期冠状动脉造影术后 CI-AKI 发生率的影响，使用生物阻抗向量分析（BIVA）评估。
共有 303 例入院时 BIVA 水平较低的患者被随机分为接受标准生理盐水（术前和术后 12 小时内 1ml/kg/h）或双倍生理盐水（2ml/kg/h）组。BIVA 水平最佳的患者（n=715）接受标准生理盐水，并纳入前瞻性登记。所有射血分数<40%的患者将生理盐水输注减半。所有患者均在血管造影前重复 BIVA。CI-AKI 定义为造影后 24 小时胱抑素 C 水平较基线升高≥10%。
与接受标准生理盐水组相比，接受双倍生理盐水组的 CI-AKI 发生率显著降低（11.5% vs. 22.3%；p=0.015）。血管造影前，双倍生理盐水组有 50%的患者达到了最佳 BIVA 水平，而标准组只有 27.7%（p=0.0001）。除射血分数<40%的患者外（p 组间=0.01），所有预先指定的亚组中均发现了相同的结果。
对稳定型冠状动脉疾病患者入院时的 BIVA 水平进行评估，可以调整血管内容量扩张，从而降低血管造影术后 CI-AKI 的发生。（个性化与标准水化预防 CI-AKI：生物阻抗分析随机试验；NCT02225431）。
