Renal Effects of Bicarbonate Versus Saline Infusion for Iso- and Lowosmolar Contrast Media in Rats
Renal Effects of Bicarbonate Versus Saline Infusion for Iso- and Lowosmolar Contrast Media in Rats
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DOI：
10.1097/rli.0b013e31822311a9
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发表时间：
2011-11-01
影响因子：
6.7
通讯作者：
Persson, Pontus B.
中科院分区：
文献类型：
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作者：
Ladwig, Mechthild;Flemming, Bert;Persson, Pontus B.
目的：水合被广泛认为是预防造影剂（CM）引起的急性肾损伤（AKI）的有效措施。碳酸氢钠 (NaHCO3) 输注是否比盐水具有更大的效果尚存在争议。多项临床试验已发现 NaHCO3 可有效预防 CM 诱发的 AKI。然而，其他人发现给予 NaHCO3 后要么没有效果，要么 CM 诱发的 AKI 发生率增加。由于肾小管吸收不同，NaHCO3 和盐水可能具有不同的冲洗肾单位的能力。在本研究中，我们比较了 NaHCO3 和盐水增强尿流量、防止肾小球滤过率 (GFR) 下降和限制尿液粘度增加的程度，这些都是由 CM 给药引起的。 材料和方法：将预热（37 摄氏度）的 CM 以 1.5 mL 推注方式注射到麻醉大鼠的胸主动脉中。研究了以下 2 个 CM：等渗碘克沙醇 (320 mg I/mL) 和低渗碘普罗胺 (370 mg I/mL)。遵循四种方案（每个方案 n = 7 只大鼠）：(1) 盐水 + 碘克沙醇，(2) 盐水 + 碘普罗胺，(3) NaHCO3 + 碘克沙醇，以及 (4) NaHCO3 + 碘普罗胺。等渗盐水或 NaHCO3 以每公斤 BM 4 mL/h 的速度输注，在 CM 给药前 60 分钟开始，并在整个 100 分钟的观察期内持续输注。通过重量分析法测量尿量，通过微粘度计测量尿液粘度，通过肌酐清除率测定GFR。结果：与输注生理盐水相比，输注NaHCO3并没有显着改变碘克沙醇和碘普罗胺对尿流率、尿粘度和GFR的影响。在碘普罗胺方案中，CM 引起的尿流量增加比各自的碘克沙醇方案高约 50%。相反，在碘克沙醇方案中，尿液粘度比相应的碘普罗胺方案高出 10 倍。在碘克沙醇方案中，GFR 短暂下降（CM 后 10-30 分钟）高达 50%，而在碘普罗胺方案中 GFR 没有下降。结论：输注生理盐水或 NaHCO3 似乎对尿流量、尿液粘度和 GFR 没有什么影响。然而，所使用的 CM 对这些措施有显着影响。碘普罗胺比碘克沙醇更能增强尿流量，而后者比碘普罗胺更大程度地增加尿液粘度，并短暂降低 GFR。
Objective: Hydration is widely accepted as an effective measure to prevent contrast media (CM)-induced acute kidney injury (AKI). Whether bicarbonate (NaHCO3) infusion has a greater effect than saline is disputed. Effective prevention of CM-induced AKI by NaHCO3 has been found by several clinical trials. However, others found either no effect or an enhanced incidence of CM-induced AKI after giving NaHCO3. Because of their different tubular resorption, NaHCO3 and saline may have a different capacity to flush the nephron. In this study, we compare the magnitudes by which NaHCO3 and saline can enhance urinary flow, prevent a decline in glomerular filtration rate (GFR), and limit an increase in urine viscosity, as caused by CM administration.Materials and Methods: Prewarmed (37 degrees C) CM were administered as 1.5 mL bolus into the thoracic aorta of anesthetized rats. Following 2 CM were studied: iso-osmolar iodixanol (320 mg I/mL) and low-osmolar iopromide (370 mg I/mL). Four protocols (n = 7 rats per protocol) were followed: (1) saline + iodixanol, (2) saline + iopromide, (3) NaHCO3 + iodixanol, and (4) NaHCO3 + iopromide. Isotonic saline or NaHCO3 were infused at a rate of 4 mL/h per kg BM, initiated 60 minutes before CM administration and continued throughout the observation period of 100 minutes. Urine volume was measured gravimetrically, urine viscosity was measured by a microviscometer, and GFR was determined by creatinine clearance.Results: As compared with saline infusions, NaHCO3 infusions did not significantly alter the effects that iodixanol and iopromide exerted on urine flow rate, urine viscosity, and GFR. In the iopromide protocols, CM-induced increase in urine flow was about 50% greater than in the respective iodixanol protocols. Conversely, in the iodixanol protocols, urine viscosity was up to 10-fold greater than in the respective iopromide protocol. In the iodixanol protocols, GFR decreased transiently (10-30 min post-CM) by up to 50%, whereas GFR did not decrease in the iopromide protocols.Conclusion: Infusing either saline or NaHCO3 seems to make little difference with regard to urine flow, urine viscosity, and GFR. However, the CM used has a significant effect on these measures. Iopromide enhances urine flow by a greater magnitude than iodixanol, whereas the latter increases urine viscosity to a larger degree than iopromide and transiently decreases GFR.