Effects of carperitide on contrast-induced acute kidney injury with a minimum volume of contrast in chronic kidney disease patients.
Effects of carperitide on contrast-induced acute kidney injury with a minimum volume of contrast in chronic kidney disease patients.
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DOI：
10.1159/000345483
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发表时间：
2012-01
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影响因子：
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通讯作者：
Murohara T
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文献类型：
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作者：
Okumura N;Hayashi M;Imai E;Ishii H;Yoshikawa D;Yasuda Y;Goto M;Matsuo S;Oiso Y;Murohara T
尽管造影剂所致的急性肾损伤(CIAKI)是血管造影术的主要并发症，但其预防措施尚不明确。使用小剂量的卡必利预防CIAKI仍然存在争议。在慢性肾脏病(CKD)合并冠心病患者行小对比容量冠状动脉造影术后，观察了卡必利对CIAKI的保护作用。我们随机将112名连续的患者分配到卡培肽组或对照组。对比剂容量保持在150ml以下。主要终点是术后48小时内血清肌酐为≥25%或≥为0.5 mg/dl的急性心肌梗死的发生率。次要终点为术后1周的肾功能改变。结果：两组在基线特征和对比度方面差异无统计学意义(卡必利组：67.4ml±38.2ml，对照组：64.8ml±20.5ml，p=0.661)。两组CIAKI发生率相似(卡必利组：8.5%，对照组：5.7%，P=0.564)。多变量分析显示，低血压≥为20毫米汞柱是发生CIAKI的重要预测因素(p=0.015)。无降压组的CIAKI发生率较低，但差异无统计学意义(CIAKI发生率：2.4%vs.5.7%，P=0.432)。结论：本研究表明，使用小对比剂可以降低CIAKI的发生率，而卡必利对CIAKI没有预防作用。我们的结果也揭示了低血压对CIAKI发展的影响。
Although contrast-induced acute kidney injury (CIAKI) is a major complication associated with angiography, the prophylaxis is not well established. Use of a low dose of carperitide for preventing CIAKI remains controversial. We examined the protective effect of carperitide on CIAKI after coronary angiography with a small contrast volume in chronic kidney disease (CKD) patients with coronary artery disease. We randomly assigned 112 consecutive patients to a carperitide or a control group. The contrast volume was kept under 150 ml. The primary endpoint was the incidence of CIAKI defined by a serum creatinine of ≥25% or a serum creatinine of ≥0.5 mg/dl from baseline within 48 h. The secondary endpoint was a change in renal function at 1 week after the procedure. Results: The baseline characteristics and contrast volumes (carperitide group: 67.4 ± 38.2 ml vs. control group: 64.8 ± 20.5 ml, p = 0.661) were comparable in the two groups. The incidence of CIAKI was similar in the two groups (carperitide group: 8.5% vs. control group: 5.7%, p = 0.564). A multivariate analysis revealed that a hypotension ≥20 mm Hg was a significant predictor of developing CIAKI in the carperitide group (p = 0.015). The incidence of CIAKI in the carperitide group without hypotension was rare, but not significantly different (carperitide group: 2.4% vs. control group: 5.7%, p = 0.432). Conclusions: This study indicated that the use of a small contrast volume suppressed the incidence of CIAKI and that carperitide had no prophylactic effect against CIAKI. Our results also revealed the impact of hypotension on the development of CIAKI in the carperitide group.