Bei Wei-Jie, Wang Kun, Li Hua-Long, Guo Xiao-Sheng, Guo Wei, Abuduaini Tuerxunjiang, Chen Shi-Qun, Islam Sheikh Mohammed Shariful, Chen Peng-Yuan, Chen Ji-Yan, Liu Yong, Tan Ning
Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Key Laboratory of Coronary Disease, Guangdong General Hospital, Guangdong Academy of Medical Sciences.
School of Medicine, South China University of Technology.
Int Heart J. 2019 Mar 20;60(2):247-254. doi: 10.1536/ihj.17-066. Epub 2019 Feb 22.
An optimal hydration volume (HV) that prevents contrast-induced acute kidney injury (CI-AKI) in patients with renal insufficiency and heart failure (HF) at a high risk of worsening HF (WHF) has not been determined. We aimed to determine a safe HV that prevents CI-AKI and WHF following coronary angiography (CAG) or percutaneous coronary intervention (PCI) in patients with renal insufficiency and HF. We recruited 1,307 patients with renal insufficiency and HF and investigated the relationships between the peri-procedural HV/weight (HV/W) ratio, and the risks of CI-AKI and WHF following CAG or PCI. Higher HV/W quartiles were associated with higher CI-AKI rates (Q1: 6.2%, Q2: 9.1%, Q3: 12.5%, and Q4: 18.7%; P < 0.001) and a greater likelihood of WHF (Q1: 2.2%, Q2: 2.7%, Q3: 4.9%, and Q4: 11.7%; P < 0.001). The multivariate analyses indicated that excessively high HV/W ratios were associated with moderately increased risks of CI-AKI (Q4 versus Q1: adjusted odds ratio [OR] 2.16, 95% confidence interval [CI] 1.17-4.00) and WHF (Q4 versus Q1: adjusted OR 3.09, 95% CI 1.21-7.88). The multivariate Cox regression analysis indicated that a higher HV/W ratio was associated with significantly increased long-term mortality (Q2 versus Q1: adjusted hazard ratio [HR] 2.36; Q3 versus Q1: adjusted HR 2.85; Q4 versus Q1: adjusted HR 2.94; all P < 0.05). In conclusion, an excessively high HV/W might be associated with a moderately increased risk of CI-AKI, WHF, and long-term mortality in patients with renal insufficiency and HF.
尚未确定能预防肾功能不全和心力衰竭（HF）且有HF恶化高风险（WHF）患者发生造影剂诱导的急性肾损伤（CI-AKI）的最佳水化量（HV）。我们旨在确定一个安全的HV，以预防肾功能不全和HF患者在冠状动脉造影（CAG）或经皮冠状动脉介入治疗（PCI）后发生CI-AKI和WHF。我们招募了1307例肾功能不全和HF患者，并研究了围手术期HV/体重（HV/W）比值与CAG或PCI后CI-AKI和WHF风险之间的关系。较高的HV/W四分位数与较高的CI-AKI发生率相关（第一四分位数：6.2%，第二四分位数：9.1%，第三四分位数：12.5%，第四四分位数：18.7%；P<0.001）以及WHF的可能性更大（第一四分位数：2.2%，第二四分位数：2.7%，第三四分位数：4.9%，第四四分位数：11.7%；P<0.001）。多变量分析表明，过高的HV/W比值与CI-AKI风险适度增加相关（第四四分位数与第一四分位数相比：调整后的优势比[OR]2.16，95%置信区间[CI]1.17-4.00）和WHF（第四四分位数与第一四分位数相比：调整后的OR 3.09，95%CI 1.21-7.88）。多变量Cox回归分析表明，较高的HV/W比值与长期死亡率显著增加相关（第二四分位数与第一四分位数相比：调整后的风险比[HR]2.36；第三四分位数与第一四分位数相比：调整后的HR 2.85；第四四分位数与第一四分位数相比：调整后的HR 2.94；所有P<0.05）。总之，过高的HV/W可能与肾功能不全和HF患者发生CI-AKI、WHF和长期死亡率的风险适度增加相关。
