Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.
CECAD, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.
Sci Rep. 2020 Mar 23;10(1):5202. doi: 10.1038/s41598-020-61895-2.
Short-term dietary restriction (DR) may prevent organ damage from ischemic or toxic insults in animals, but clear evidence in humans is missing. While especially intraarterial administration of contrast media represents a cause of hospital-acquired acute kidney injury (AKI), targeted preventive strategies are not available. This trial investigated the feasibility and effectiveness of pre-interventional DR for preventing AKI in patients undergoing percutaneous coronary intervention (PCI). Patients were randomized to receive a formula diet containing 60% of daily energy requirement (DR group) or ad-libitum food during the 4-day-interval before PCI. Primary endpoint was change of serum creatinine 48 h after PCI (Δcreatinine). Further analyses included incidence of AKI and safety evaluation. Δcreatinine post PCI in the DR group vs. the control group did not show any difference (DR: 0.03(-0.15,0.14)mg/dL vs. control: 0.09(-0.03,0.22)mg/dL;p = 0.797). Subgroup analyses revealed a significant beneficial impact of DR in patients that received ≤100 ml of contrast agent (DR n = 26: Δcreatinine -0.03(-0.20,0.08)mg/dL vs. control n = 24: Δcreatinine 0.10(-0.08,0.24)mg/dL; p = 0.041) and in patients with ≤2 risk factors for AKI (DR: n = 27; Δcreatinine -0.01(-0.18,0.07)mg/dL vs. control n = 31: Δcreatinine 0.09(-0.03,0.16)mg/dl; p = 0.030). Although the primary endpoint was not met, the results of this trial suggest a beneficial impact of DR in low-to-moderate risk patients.
短期饮食限制（DR）可能预防动物的缺血或毒性损伤，但在人类中缺乏明确的证据。虽然动脉内应用对比剂特别代表了医院获得性急性肾损伤（AKI）的原因，但没有针对性的预防策略。这项试验研究了在接受经皮冠状动脉介入治疗（PCI）的患者中，预防性 DR 预防 AKI 的可行性和有效性。患者被随机分为接受含有每日能量需求 60%的配方饮食（DR 组）或 PCI 前 4 天内随意进食的饮食（对照组）。主要终点是 PCI 后 48 小时血清肌酐的变化（Δcreatinine）。进一步的分析包括 AKI 的发生率和安全性评估。DR 组与对照组相比，PCI 后 Δcreatinine 没有差异（DR：0.03（-0.15，0.14）mg/dL 与对照：0.09（-0.03，0.22）mg/dL；p=0.797）。亚组分析显示，在接受 ≤100ml 造影剂的患者中，DR 有显著的有益影响（DR n=26：Δcreatinine -0.03（-0.20，0.08）mg/dL 与对照 n=24：Δcreatinine 0.10（-0.08，0.24）mg/dL；p=0.041）和 AKI 风险因素 ≤2 的患者中（DR：n=27；Δcreatinine -0.01（-0.18，0.07）mg/dL 与对照 n=31：Δcreatinine 0.09（-0.03，0.16）mg/dl；p=0.030）。尽管主要终点未达到，但这项试验的结果表明，DR 对低至中度风险患者有有益的影响。
