Department of Medical Imaging, Taipei Medical University Hospital, 252 Wu-Hsing St, Taipei City 110, Taiwan.
Department of Biomedical Imaging and Radiological Science, National Yang-Ming University, Taipei, Taiwan.
AJR Am J Roentgenol. 2020 Jul;215(1):15-24. doi: 10.2214/AJR.19.22325. Epub 2020 Apr 29.
The purpose of this study was to determine whether contrast medium volume and method of administration and baseline estimated glomerular filtration rate influence the efficacy of prophylactic hydration for prevention of acute kidney injury after contrast administration. An online search of PubMed conducted on August 25, 2017, produced a total of 697 studies. After the reports were reviewed, nine were included in this study. The extracted data on all patients in these studies were separated into a group that received prophylactic hydration and a group that did not. The following three parameters were used for subgroup analysis: contrast medium volume, contrast administration method, and baseline estimated glomerular filtration rate. The test was performed, and study-level odds ratios with 95% CIs and values were calculated. Tests of heterogeneity were conducted. When the volume of contrast agent administered exceeded 100 mL, hydration was beneficial in the prevention of contrast-induced acute kidney injury (odds ratio, 0.546). If the volume was less than 100 mL, hydration had no efficacy in preventing contrast-induced acute kidney injury (odds ratio, 0.917). Administration route and baseline estimated glomerular filtration rate exerted no effect on the efficacy of prophylactic hydration. For patients who receive less than 100 mL of contrast medium, the prevalent practice for contrast-enhanced CT studies, prophylactic hydration may not be necessary, regardless of the estimated glomerular filtration rate or route of contrast administration. For patients undergoing procedures requiring administration of large volumes of contrast medium, however, hydration is recommended to prevent contrast-induced acute kidney injury.
本研究旨在确定对比剂用量和给药方式以及基线估计肾小球滤过率是否会影响预防性水化对预防对比剂给药后急性肾损伤的疗效。2017 年 8 月 25 日，我们通过在线搜索 PubMed，共获得了 697 项研究。在对这些报告进行审查后，有 9 项研究被纳入本研究。这些研究中所有患者的提取数据分为接受预防性水化组和未接受预防性水化组。采用以下三个参数进行亚组分析：对比剂用量、对比剂给药方式和基线估计肾小球滤过率。采用 检验进行检验，并计算研究水平的优势比（OR）及其 95%可信区间（95%CI）和 值。进行了异质性检验。当给予的造影剂体积超过 100ml 时，水化在预防对比剂诱导的急性肾损伤方面是有益的（OR，0.546）。如果体积小于 100ml，则水化在预防对比剂诱导的急性肾损伤方面无效（OR，0.917）。给药途径和基线估计肾小球滤过率对预防性水化的疗效没有影响。对于接受少于 100ml 造影剂的患者，对于增强 CT 研究的常见做法，无论估计肾小球滤过率或对比剂给药途径如何，预防性水化可能都不是必需的。然而，对于需要给予大体积对比剂的患者，建议进行水化以预防对比剂诱导的急性肾损伤。
