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Effects of Low Dose Furosemide on Preventing Contrast Induced Nephropathy at the Basic of Adequate Hydration in Patients Undergoing Coronary Angiography

Author: LuRui
Tutor: GuGuoQiang
School: Hebei Medical University
Course: Internal Medicine
Keywords: Contrast-induced nephropathy Small doses of furosemide Hydration Serum creatinine levels Serum creatinine clearance Glomerular filtration rate Coronary angiography
CLC: R692
Type: Master's thesis
Year: 2011
Downloads: 60
Quote: 0
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Abstract

Objective: Contrast-induced nephropathy is no other reason to explain acute kidney injury occurred within 48 h after application of the contrast agent. The accepted definition of contrast-induced nephropathy: 25% or higher 0.5 mg elevated serum creatinine levels compared to baseline values ??within 48 hours after the use of contrast agents. For most people, after the application of contrast agents, elevated serum creatinine levels of 24-48 hours, 3-5 days peaked seven days to its original level. Cause contrast-induced nephropathy, the exact mechanism is not clear. The possible reasons that cause contrast-induced nephropathy renal medullary ischemia, a tubular direct toxicity, the activation of oxygen free radicals. Contrast agent into the blood vessels caused transient renal vascular relaxation, persistent contraction. The renal hemodynamics change in the renal medullary ischemia and hypoxia. Subsequently, the generation of oxygen free radicals and oxidative stress caused by ischemia and reperfusion injury. In addition, the viscosity and high permeability of the contrast agent led to a slowdown in renal blood flow and renal vascular thrombosis, aggravated the injury of the kidney tissue. Contrast-induced nephropathy is self-limiting, but the combined contrast-induced nephropathy risk factors in patients may cause sustained renal injury requiring long-term dialysis. Contrast-induced nephropathy has caused widespread concern of cardiologists. The currently accepted method for the prevention of contrast-induced nephropathy preventive hydration and control risk factors. In addition, the application of sodium bicarbonate, N-acetylcysteine, remains controversial. Furosemide is commonly used loop diuretics, which can be by inhibiting the reabsorption of sodium chloride, the lower tubular metabolism of oxygen consumption; transient increases glomerular plasma flow, without increasing the glomerular filtration rate; at relatively high concentrations, does not rely on prostaglandin renal vascular relaxation, reducing renal vascular resistance and increased renal blood flow, reduced renal injury. Therefore, some scholars have envisaged application furosemide renal vascular contrast agent to reduce the drug concentration, reduced renal medullary oxygen consumption, thereby reducing kidney damage, but failed to get the desired effect. After recent years of the study, it was found that the hydration therapy in reducing contrast-induced nephropathy occurred in the leading role. Previous application furosemide can not make up enough moisture and furosemide overdose, resulting in effective renal hypoperfusion, may be the main reason for treatment failure. The purpose of this study is to observe fully hydrated based on a small dose of furosemide whether the prevention of contrast-induced nephropathy has additional benefits. Method: Select the line of Cardiology cath lab from September 2009 to February 2011 a total of 759 cases of coronary angiography and (or) PCI patients. 545 cases of male and female 214 cases, with an average age of 58.00 (14.00) years, mean weight 71.00 (13.00) kg iopromide injection (370), intraoperative mean dose 60.00 (40.00) ml. Eligible patients were randomly divided into the furosemide group and the control group, which furosemide group 422 cases, 337 cases of the control group. Before coronary angiography to check the level of serum creatinine, glomerular filtration rate calculated according to the MDRD formula: GFR (ml/min/1.73m ^{2 ) = 186 × (Scr) ^{-1.154 < / sup> × (age) ^{-0.203 (× 0.742 women); calculated serum creatinine clearance based on the Cockcroft-Gault formula: Ccr (ml / min) = [(140 - age) x weight x ( 0.85 women)] / (72 × Scr) and. 4 hours before surgery to patients 1ml/kg/h saline hydration after furosemide group was given furosemide 20mg slow bolus control group without any treatment. The postoperative two groups continue to 1ml/kg/h saline hydration to last up to 24 hours. After 48 hours to review the level of serum creatinine, calculated serum creatinine clearance and glomerular filtration rate. Contrast-induced nephropathy is defined as a serum creatinine within 48 hours after application of contrast agent increased compared with the previous 25% or higher 0.5 mg. Statistical analysis was performed using SPSS16.0 software. Measurement data were presented as mean ± standard deviation ((x | -) ± s) or median (interquartile range); Segment information rate (%). Between the two groups of serum creatinine levels, serum creatinine clearance and glomerular filtration rate to take repeated measurements covariance analysis; groups within the preoperative and postoperative indicators t test or rank sum test was used to compare the analysis ; incidence of contrast-induced nephropathy using the chi-square test. Logistic regression analysis of risk factors for screening contrast-induced nephropathy. P lt; 0.05 for significant statistical difference. Results: The clinical conditions such as age, height, weight, sex between furosemide and control groups was no significant difference (P gt; 0.05). More patients taking statins in the control group (P lt; 0.05). The furosemide group postoperative serum creatinine levels higher than those before, no statistical significance (P gt; 0.05), serum creatinine clearance and glomerular filtration rate is lower than the preoperative, no statistical significance (P gt; 0.05 ); control group, postoperative serum creatinine levels higher than before surgery, was statistically significant (P lt; 0.05); glomerular filtration rate and creatinine clearance rate is lower than the preoperative statistical significance (P lt; 0.05) . Furosemide and control groups before and after the application of contrast medium degree of changes in the level of serum creatinine, serum creatinine clearance and glomerular filtration rate and extent of furosemide group compared to the control group, serum creatinine levels, Serum creatinine clearance rate, the more obvious the extent of the decline in glomerular filtration rate (P lt; 0.05). The occurrence of contrast-induced nephropathy furosemide group was 8.06%, and the occurrence of contrast-induced nephropathy in the control group was 14.24%, a statistically significant (P lt; 0.05). Logistic regression analysis showed that furosemide has a protective effect on contrast-induced nephropathy, women, acute myocardial infarction, taking angiotensin-converting enzyme inhibitors (ACEI) and contrast-induced nephropathy occurred related. Conclusion: In this study, by comparing furosemide group and the control group, preoperative and postoperative serum creatinine levels, serum creatinine clearance and glomerular filtration rate changes, two sets of contrast-induced nephropathy incidence data, show that in the full hydration on the basis of a small dose of furosemide is possible to reduce the incidence of contrast nephropathy.}}}

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