Department of Medicine, Duke University, Durham, North Carolina.
Division of Cardiology and the McAllister Heart Institute, University of North Carolina, Chapel Hill, North Carolina.
Am J Cardiol. 2021 Nov 15;159:1-7. doi: 10.1016/j.amjcard.2021.08.017.
Hydration is recommended to prevent contrast associated-acute kidney injury (CA-AKI) but interactions between blood pressure, left ventricular end diastolic pressure (LVEDP) and hydration status on CA-AKI are incompletely understood. This analysis presents the results of a single-center prospective study of patients undergoing coronary angiography with a predicted risk of CA-AKI >14%. 146 patients were enrolled with a mean (±SD) age of 71 ± 11 years; 94 (64.4%) were men, 142 (97.3%) had hypertension, 96 (65.8%) had diabetes mellitus and the mean (SD) serum creatinine was 1.21 ± 0.36 mg/dl. CA-AKI occurred in 31 (21%) patients. There were no significant differences in demographics, comorbidities, renal function, LVEDP, systolic blood pressure, diastolic blood pressure, heart rate, mean arterial pressure or pulse pressure in patients who developed versus those who did not develop CA-AKI. There was no association between the amount of peri-procedure intravenous fluids and change in creatinine postprocedure. In multivariate analysis, hemoglobin, the time that the patient was fasting from solids (NPO time), and contrast volume were associated with the development of CA-AKI. There was a highly significant interaction (p = 0.0028) between the amount of intravenous fluids, NPO time and contrast volume and changes in postprocedure creatinine. In summary, hemoglobin, NPO time and contrast volume, but not hemodynamic variables, correlated with worsening renal function following coronary angiography in this population of high-risk patients. Results suggested that intravenous hydration is important in subgroups of patients depending on NPO time and contrast volume.
水化推荐用于预防对比剂相关急性肾损伤（CA-AKI），但血压、左心室舒张末期压（LVEDP）和水化状态之间的相互作用对 CA-AKI 的影响尚不完全清楚。本分析报告了一项针对接受预测 CA-AKI 风险>14%的冠状动脉造影患者的单中心前瞻性研究的结果。共纳入 146 例患者，平均（±SD）年龄为 71±11 岁；94 例（64.4%）为男性，142 例（97.3%）患有高血压，96 例（65.8%）患有糖尿病，血清肌酐平均值（SD）为 1.21±0.36mg/dl。31 例（21%）患者发生 CA-AKI。发生 CA-AKI 与未发生 CA-AKI 的患者在人口统计学、合并症、肾功能、LVEDP、收缩压、舒张压、心率、平均动脉压或脉压方面无显著差异。围手术期静脉输液量与术后肌酐变化之间无关联。多变量分析显示，血红蛋白、患者禁食固体（NPO 时间）时间和对比剂用量与 CA-AKI 的发生有关。静脉输液量、NPO 时间和对比剂用量与术后肌酐变化之间存在高度显著的相互作用（p=0.0028）。血红蛋白、NPO 时间和对比剂用量与该高危人群行冠状动脉造影后肾功能恶化相关，但血流动力学变量无关。结果表明，根据 NPO 时间和对比剂用量，静脉补液在某些患者亚组中很重要。
