Effect Of 24 Hours' Different Intravenous Infusion Volume After Coronary Angiography On Contrast-induced Renal Damage

Objective:With the increasing aging of population,the incidence of cardiovascular and cerebrovascular diseases is increasing.And the number of patients undergoing percutaneous coronary intervention(PCI)is increasing.As a result,the number of patients who developed contrast-induced nephropathy(CIN)is increasing too.At present,CIN has become the third major cause of iatrogenic renal failure.However,there are still rare effective therapies to reverse the pathological process of CIN in clinical practice.The most effective intervention is still limited to adequate hydration prevention.This research was designed to observe and analyze the effects of different 24 hours' intravenous fluid after angiography on renal damage induced by contrast media in patients undergoing coronary angiography.Methods:We enrolled the patients who underwent selective coronary angiography or percutaneous coronary intervention from December 2015 to March 2016 in emergency internal medicine chest pain center ward of Qilu Hospital of Shandong University.The patients with NYHA grade ?,IV heart failure,severe renal insufficiency,or patients who used nephrotoxic drugs during hospitalization were excluded.All the patients were given the same level of venous hydration with 0.9%sodium chloride solution at the rate of 1.5mL-kg-1·h-1 during 6 hours before and after operation according to the 2012 Kidney Disease:Improving Global Outcomes Guidelines(KDIGO).5ml venous blood was extracted at the time point of 20min before and 48h after operation respectively to detect the renal function.We summarized the amount of 24 hours' intravenous fluids after the operation of all patients.And the patients were divided into three groups according to the difference of the amount of liquid,Group A<1000ml;1000ml ? Group B<1500ml;Group C?1500ml.We researched the question by comparing the following statistics between different groups at admission,before operation and 48 hours after operation,which are serum creatinine(SCr),blood urea nitrogen(BUN),cystatin C(Cys-C)and the incidence rate of CIN.Results:A total of 223 patients were included.Baseline data such as age,sex,weight,blood pressure,leucocyte,hematocrit,platelet levels at admission and Scr,BUN and Cys-C levels at admission and before operation showed no significant differences among these three groups.There were no significant differences among these three groups in the history of previous diseases,such as the ratios of diabetes cases,cerebrovascular disease cases and myocardial infarction cases.There were no significant differences in the proportion of CCB,?-blocker and statins use during the hospitalization among these three groups.The dosage of contrast agent in group A was significantly lower than those of group B and C(P<0.05).There was no significant difference in the dosage of contrast agents used between group B and group C.The levels of Scr and Cys-C at 48 hours after operation in group B or group C were significantly higher than that in group A(P<0.05).The levels of Scr and Cys-C in group C were significantly lower than that in group B(P<0.05).The incidence of CIN in group B was higher than that in group A and C(P<0.05).Conclusions:1.The enhancement of intravenous fluids during 24 hours after angiography could not completely reduce the renal function injury caused by increased use of contrast agent.2.For the patients with the same dosage use of the contrast agent,the enhancement of intravenous fluids during 24 hours after angiography could reduce the renal function damage caused by the contrast agent and the incidence of CIN.