Michel Pablo, Amione-Guerra Javier, Sheikh Omar, Jameson Lauren C, Bansal Shweta, Prasad Anand
Department of Medicine, Division of Cardiology, Rutgers New Jersey Medical School, Newark.
Department of Medicine, Division of Cardiology, University of Texas Health Science Center, San Antonio, Texas.
Catheter Cardiovasc Interv. 2021 Nov 15;98(6):1120-1132. doi: 10.1002/ccd.29387. Epub 2020 Nov 13.
To perform a detailed analysis of published data regarding intravascular volume expansion to prevent contrast-associated acute kidney injury (CA-AKI) and to determine if an ideal dose of IV fluids can be recommended.
Administration of contrast media during invasive angiography is associated with CA-AKI. Intravascular volume expansion is the most effective intervention to prevent CA-AKI, yet evidenced based protocols are lacking.
Literature review and meta-analysis of randomized controlled trials (RCT) of patients receiving IV volume expansion as prophylaxis for CA-AKI was performed. Normal saline, Lactated Ringer's and sodium bicarbonate were included. The primary outcome was incidence of CA-AKI.
37 RCTs studying 12,166 patients were included. Mean age was 67 ± 5 years, 70% of the patients were male. 68% had chronic kidney disease, 41% diabetes, and 30% heart failure. The incidence of CA-AKI was 9.5% (95% CI: 8-12%). IV expansion versus no volume administration was associated with a lower risk of CA-AKI (RR:0.62; 95% CI: 0.49-0.77, p < .001). Intensive IV volume expansion was associated with a reduced risk of CA-AKI(RR: 0.66; 95%CI: 0.52-0.85, p < .01). The intensive IV volume expansion arm received significantly more fluids than the standard protocols: 1,574(1,123 - 1,913) ml versus 849(558-1,067) ml (p = .03) without significant difference in the duration of infusion (median of 12 vs. 17 hr, p = .1) or pulmonary edema (1.7% vs 1.3%, p = .7).
Despite high variability in protocols used, IV volume expansion is effective in preventing CA-AKI. Intensive IVF expansion (median 1.6 L over 17 hr) was associated with decreased risk of CA-AKI.
对已发表的有关血管内容量扩充以预防对比剂相关性急性肾损伤（CA-AKI）的数据进行详细分析，并确定是否可以推荐理想的静脉输液剂量。
侵入性血管造影术中使用对比剂与CA-AKI相关。血管内容量扩充是预防CA-AKI最有效的干预措施，但缺乏循证方案。
对接受静脉容量扩充作为CA-AKI预防措施的患者的随机对照试验（RCT）进行文献综述和荟萃分析。纳入生理盐水、乳酸林格氏液和碳酸氢钠。主要结局是CA-AKI的发生率。
纳入了37项研究12166例患者的RCT。平均年龄为67±５岁，70%的患者为男性。68%患有慢性肾脏病，41%患有糖尿病，30%患有心力衰竭。CA-AKI的发生率为9.5%（95%CI：8%-12%）。静脉扩容与不进行容量输注相比，CA-AKI风险较低（RR：0.62；95%CI：0.49-0.77，p<0.001）。强化静脉容量扩充与CA-AKI风险降低相关（RR：0.66；95%CI：0.52-0.85，p<0.01）。强化静脉容量扩充组比标准方案组接受的液体量明显更多：1574（1123-1913）ml对849（558-1067）ml（p=0.03），输注持续时间（中位数12小时对17小时，p=0.1）或肺水肿（1.7%对1.3%，p=0.7）无显著差异。
尽管使用的方案存在高度变异性，但静脉容量扩充对预防CA-AKI有效。强化静脉输液扩充（17小时内中位数1.6L）与CA-AKI风险降低相关。
