The Reno-protection Effect Of Perioperative Hydration In Patients With Chronic Kidney Disease Undergoing Coronary Angiogram And/or Percutaneous Coronary Intervention

Objective:The aim of the study is to investigate the mid-,long-term reno-protection effect of perioperative hydration and compare the distinction in renal function protection between four different hydration protocols in the patients with chronic kidney disease(CKD)undergoing coronary angiography(CAG)and/or percutaneous coronary intervention(PCI).Method:A total of 140 consecutive CKD patients were prospectively and randomly assigned to four groups which adapted different hydration methods,including the normative vein hydration group,the short-time conventional speed vein hydration group,the short-time rapid hydration by vein combined with oral hydration group and the simple vein hydration combined with main oral hydration group.The serum creatinine(SCr)were measured on admission and at 24 hours,7 days,1 month after the CAG and/or PCI.The glomerular filtration rate was calculated by the formula of MDRD.Analyze the SCr,eGFR in all patients on admission and at 24 hours,7 days,1 month after the CAG and/or PCI.Besides,Subgroup was analyzised based on risk factors such as elder,diabetes,hypertension,heart failure.What’s more,the SCr and eGFR of 4 groups with different hydration protocols were compared on admission,at 24 hours,7 days,1 month after the CAG and/or PCI,respectively.Result:1)The SCr in all patients at 24 hours after the procedure was significantly lower than that abserved on admission(91.29±2.32μmol/L vs 97.32±2.36μmol/L,P<0.01).So was the SCr at 1 month after the CAG and/or PCI(90.39±2.42 μmol/L vs 97.32±2.36μmol/L,P<0.01).The SCr at 1 week after the contrast exposure was lower than that abserved on admission(95.73±2.50μmol/L vs 97.32±2.36μmol/L,P=0.177).2)And the eGFR in all patients at 24 hours after the procedure in patients was significantly higher than that observed on admission(67.9311.51mL/min/1.73m2 vs 62.34±1.18mL/min/1.73m2,P<0.01).So was the eGFR at 1 week(64.36±1.39mL/min/1.73m2 vs 62.34±1.18mL/min/1.73m2,P<0.05),at 1 month(69.02±1.48mL/min/1.73m2 vs 62.34±1.18mL/min/1.73m2,P<0.01)after the CAG and/or PCI.3)Subgroup analysis found that the CKD patients with advanced age,diabetes mellitus and hypertension were abserved the parallel renal protective effect with the overall study population with chronic kidney disease(P<0.05).Reno-protection was not observed in patients with risk factor of heart failure(P>0.05).4)There wasn’t statistical significance to the SCr of four different hydration protocols at 24 hours(F=0.262,P=0.853),at 1 week(F=0.189,P=0.904),at 1 month(F=0.207,P=0.891)after the procedure.So was the eGFR of four groups at 24 hours(F=0.633,P=0.595),at 1 week(F=1.148,P=0.332)and 1 month(F= 1.261,P=0.291).Conculusion:1)The perioperative hydration dose exert a mid-,long-term protective effect on the renal function in the patients with chronic kidney disease(CKD)undergoing coronary angiography(CAG)and/or percutaneous coronary intervention(PCI).The reno-protection in CKD patients combined with risk factors,such as the advanced age,hypertension,heart dysfunction or diabetes mellitus,is the same as the overall population.2)There was no significance between different hydration protocols over the a mid-,long-term renal protective effectiveness.