The Prevention Of Intravenous Infusion Of Nicorandil On Contrast-induced Nephropathy In Patients With Mild And Moderate Renal Insufficient

Background:With the rapid development of diagnostic level and interventional therapy technology,especially the extensive development of cardio-cerebrovascular interventional therapy,the incidence of contrast induced nephropathy is increasing,which has become the third most common cause of hospital-acquired acute renal injury.That's about 12 percent,compared with 44 percent of patients with existing kidney failure.CIN may lead to prolonged hospitalization,increased costs,hemodialysis,and even kidney transplantation.Therefore,we should pay more attention to the adverse event-a major complication after CAG..Therefore,CIN is an important complication after coronary angiography and causes us to reconsider the effect of contrast agent on the kidney.Unfortunately,,there are no effective drugs to prevent CIN except for hydration.Nicorandil is a hybrid compound derived from adenosine triphosphate(ATP)-sensitive potassium channel(K-ATP channel)opener and nitric oxide(NO)donor,which has a relaxing effect on coronary arteries,especially small vessels.Thus increasing coronary artery blood flow,it is widely used in the treatment of angina pectoris and acute heart failure in European countries.A large number of glomeruli in the kidney are also microvascular balls in nature,similar in some ways to the heart microcirculatory system.Animal experiments abroad have proved that intravenous nicorandil has protective efect on the kidney of mice treated with contrast agent.Oral nicorandil is also used to prevent contrast-induced nephropathy in clinic,but the results are not uniform.However,the prophylaxis of CIN by intravenous infusion of nicorandil,especially the prevention of CIN in patients with renal insufficiency,is not related to the clinical study.Objective:To investigate the prevention of c contrast induced nephropathy after coronary angiography in patients with mild and moderate renal insufficiency by intravenous infusion of nicorandil and the early protection of renal function post operation.Methods:The clinical data of 150 patients diagnosed with coronary heart disease complicated with renal dysfunction who underwent CAG or PCI was collected from the Heart Interventional Center of the first Medical Center of the General Hospital of the Chinese people's Liberation Army,from October 2017 to October 2018.They were randomly divided into control group(75 cases)and trial group(75 cases),regardless of age and sex.The control group was treated with routine continuous intravenous hydration:0.9%Nacl solution was continuously dripped by 1.0ml/(h·kg)from 12 h before operation to 24 h after operation.The experimental group was continuously dripping Nicorandil injection for 12 hours before operation and 24 hours after operation by 1.0ml/(h kg).The serum creatinine(Scr),glomerular filtration rate(eGFR),)urinary ? 2-microglobulin(? 2-MG),)cystatin C(Cys C)were measured on admission before CAG and at 24h,48h after CAG.The occurrence of contrast induced nephropathy(CIN)of the two groups was observed.Adverse reactions were recorded in both groups.Results:There was no significant difference between the two groups about baseline data(p>0.05):the experimental group and the control group had sex,age,height,body mass index,hypertension,diabetes mellitus,history of smoking and drinking,baseline medication history(aspirin,clopidogrel,statins,metformin,etc.)and Mehran scores,serum creatinine,cystatin C,urine ?-2 microglobulin before CAG.However,significant rise was observed in SCr and Cys-C levels at 24 and 48 h(p<0.05),Nicorandil group tended to have a lower SCr,Cys-C and urine ?2-MG levels than control group at 48 h after CAG(SCr,90.88±18.28 vs.105.46±31.86 umol/L,p=0.029;Cys-C,1.28±0.45vs.1.52±0.76 umol/L,p=0.006;urine ?2-MG 0.063±0.064 vs.0.104±0.043 umol/L,p=0.009).Correspondingly,the incidence of CIN was dramatically lower in Nicorandil group than control group(9.33%vs 1.33%,p=0.029).Multivariate Logistic regression analysis showed that eGFR ?60 mL/min/1.73m2(OR=3.882,95%CI=1.488?10.127,P=0.016),diabetes mellitus(OR=1.432,95%CI= 0.617?4.573,p=0.027),Contrast medium dose ? 150mL(OR=5.996,95%CI=2.307?15.169,p=0.001),Mehran score>6(OR=1.243,95%CI=0.423-3.674,p=0.013)were independent risk factors for CIN within 48 hours after operation.Nicorandil(OR=1.158,95%CI=0.386-3.912,p=0.034)is an independent protective factor for preventing CIN within 48 hours after operation.Conclusion:Intravenous infusion of nicorandil has mild and moderate renal protective function and can effectively prevent the occurrence of contrast-induced nephropathy after coronary angiography in patients with renal insufficiency..