A Multicentre Study On The Preventive Effects Of Alprostadil On Contrast-induced Acute Kidney Injury

Objective:To investigate the preventive effects,mechanism and safety of alprostadil on the prevention of contrast induced acute kidney injury(CIAKI)in patients with coronary heart disease(CHD)undergoing percutaneous coronary intervention(PCI).Methods:The study enrolled Seven hundred patients who were about to undergo PCI in Tianjin first center Hospital ? Tianjin 4th center Hospital ? TEDA International Cardiovascular Hospital?Tianjin Chest Hospital from January 2015 to december 2016.All patients were divided into two groups randomly : alprostadil treatment group(n=350)and conventional treatment group(n=350).Before PCI,alprostadil treatment group patients were given alprostadil plug hydration treatment,conventional treatment group patients were only given simple hydration treatment.Then the data of the basic clinical information of patients and the dosage of contrast was collected.the levels of Blood urea nitrogen(BUN),eGFR,serum Scr,72 h neutrophil gelatinase associated protein(NGAL)in preoperative and postoperative PCI to explore whether alprostadil has a preventive effect on CIAKI;By comparing the effects of tumor necrosis factor ?(TNF-?),superoxide dismutase(SOD),glutathione(GSH),interleukin(IL-6)to explore the renal protective mechanism of alprostadil,meanwhile,recording the adverse reactions of alprostadil treatment group which can induce hypotension? heart and kidney adverse events.Results:1.The basic clinical information of two groups is no difference(P>0.05).2.The levels of eGFR?BUN?Scr?TNF-??IL-6?SOD?NGAL and GSH have no statistically significant in both of groups before PCI(P>0.05).3.There were 8 cases of CIAKI in alprostadil treatment group,the incidence rate was 2.3%,and 28 cases of CIAKI in conventional treatment group,the incidence rate was 8%.The incidence of CIAKI in the two groups(2.3% vs 8%)was statistically significant(P <0.05).4.There were no changes of the levels of Scr?eGFR?BUN reflecting the renalfunction in both of groups before and after PCI 72h(P>0.05).5.The levels of IL-6?SOD?TNF-??NGAL and GSH 72 h in both of groups after PCI were higher than the levels before PCI 72h(P<0.05).6.In the alprostadil group after PCI 72 h,the levels of NGAL?IL-6 and GSH were lower than the conventional treatment group(P<0.05).7.The safety of the two groups of patients during hospitalization medication is good.Conclusions:1.The use of alprostadil can induce the incidence of CIAKI obviously in Perioperative period.2.Alprostadil has protective effect on renal in the CHD patients undergoing percutaneous coronary intervention.The prevention mechanism may be due to the anti-inflammatory effect,antioxidant effect and the dilate kidney vessels effect of alprostadil.3.Alprostadil has good safety.