Zaki Hany A, Bashir Khalid, Iftikhar Haris, Alhatemi Mubarak, Elmoheen Amr
Emergency Medicine, EgBEM, MRCEM, Hamad Medical Corporation, Doha, QAT.
Medicine, Qatar University, Doha, QAT.
Cureus. 2022 May 8;14(5):e24825. doi: 10.7759/cureus.24825. eCollection 2022 May.
Contrast media administration to patients during cardiac events increases the risk of developing contrast-induced nephropathy (CIN). CIN is among some complications usually associated with the percutaneous coronary intervention and may result in acute renal failure. Several risk factors are associated with CIN. These risk factors include; age (elderly patients), pre-existing renal impairment, diabetes mellitus, and the use of high osmolar contrast media. Studies have shown that several measures such as using low osmolar contrast media, N-acetylcysteine, intravenous sodium bicarbonate, and hydration through oral or intravenous fluid administration play a significant role in CIN incidence reduction. Hydration using intravenous fluid, especially saline solution, has been critical in preventing CIN. Prehydration using the intravenous fluid before contrast media administration is vital. A systematic literature search with meta-analysis for relevant and original articles was carried out from 2000 to 2022 on databases such as PubMed, Cochrane Library, Google Scholar, ScienceDirect, Web of Science, and Embase. The search on the databases was based on various keywords related to intravenous fluid and CIN. The studies that met the inclusion criteria were critically analyzed, and data such as study design, interventions, participants, and outcomes of the research were retrieved. Out of the 784 results yielded during the initial search, ten articles met the eligibility criteria and were included in the study. The data analysis obtained from the included studies showed that pretreatment using intravenous fluid has conflicting results. Some studies showed that hydrating patients using intravenous fluid before contrast media administration significantly reduces the risk of CIN. In contrast, others claimed that intravenous fluid has minimal impact on preventing CIN. Despite the different investigations conducted on CIN, it remains insufficiently understood. From the analysis, most of the studies support that intravenous fluid administration decreases the occurrence of CIN in patients that receive contrast media. The analysis also has established that oral hydration is similar to intravenous fluid administration in reducing CIN incidence.
在心脏事件期间给患者使用造影剂会增加发生造影剂肾病（CIN）的风险。CIN是经皮冠状动脉介入治疗通常伴随的一些并发症之一，可能导致急性肾衰竭。有几个风险因素与CIN相关。这些风险因素包括：年龄（老年患者）、既往存在的肾功能损害、糖尿病以及使用高渗造影剂。研究表明，使用低渗造影剂、N - 乙酰半胱氨酸、静脉注射碳酸氢钠以及通过口服或静脉输液进行水化等措施在降低CIN发生率方面发挥着重要作用。使用静脉输液进行水化，尤其是生理盐水溶液，对于预防CIN至关重要。在造影剂给药前使用静脉输液进行预水化至关重要。从2000年到2022年，在PubMed、Cochrane图书馆、谷歌学术、ScienceDirect、科学网和Embase等数据库上进行了系统的文献检索并进行荟萃分析，以查找相关的原始文章。在数据库上的搜索基于与静脉输液和CIN相关的各种关键词。对符合纳入标准的研究进行了严格分析，并检索了研究设计、干预措施、参与者和研究结果等数据。在初步搜索产生的784个结果中，有10篇文章符合纳入标准并被纳入研究。从纳入研究中获得的数据分析表明，使用静脉输液进行预处理的结果存在矛盾。一些研究表明，在造影剂给药前使用静脉输液对患者进行水化可显著降低CIN的风险。相比之下，其他研究则声称静脉输液对预防CIN的影响极小。尽管对CIN进行了不同的研究，但人们对它的了解仍然不足。从分析中可以看出，大多数研究支持静脉输液给药可降低接受造影剂患者中CIN的发生率。分析还确定，口服水化在降低CIN发生率方面与静脉输液给药相似。
