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The Prevention Effect of Hydration Therapy on Contrast-induced Nephropathy of Diabetic Nephropathy Patients

Author: TanMingHong
Tutor: ChenBing
School: Third Military Medical University
Course: Endocrine and metabolic diseases
Keywords: diabetic nephropathy contrast-induced nephropathy non-ionic iso-osmolar contrast medium Saline hydration therapy
CLC: R692.9
Type: Master's thesis
Year: 2011
Downloads: 49
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Abstract

Background and ObjectiveDiabetic nephropathy is a major complication of diabetes, which occurs in 47.66% of the patients. Patients with diabetic nephropathy in clinical often due to be multi-detector row spiral ranks computed tomography examination, which need to use iodine contrast media inevitablly. The current global use of iodine contrast media has reached hundreds of millions of people-time each year. The expansion in the use of iodinated contrast media means that the incidence of CIN, which not only does negatively impact clinical outcomes, but it is also associated with increased healthcare costs, is likely to grow rapidly. So it is necessary to study how to reduce the diabetic patients in contrast-induced nephropathy occurred in check.Contrast-induced nephropathy (CIN) is defined as either a greater than 25% increase of serum creatinine or an absolute increase in serum creatinine of 0.5 mg/dL after a radiographic examination using a contrast agent. CIN is the third most common cause of hospital-acquired renal failure and is a substantial cause of morbidity and mortality. The rate of CIN for non-selected population can vary from 1% to 6% and this will be up to 50% for high-risk group. CIN typically results in acute renal dysfunction with the increase in creatinine level occurring within 24-48 hours that often peaks at 3-5 days. However, there is currenttly no efficient and cost-effective treatment measures, mainly focusing on prevention, and the prevention effect of hydration therapy has become widely recognized as a regular means of prevention of CIN. This paper studies the prevention effect of hydration therapy on contrast-induced nephropathy (CIN) of diabetic nephropathy patients using non-ionic iso-osmolar contrast medium.Methods1. Clinical data A total of 80 diabetic nephropathy patients who were admitted to endocrinology department of southwest hospital from January 2007 to December 2010 were involved in this study. The age, sex, height, weight, body mass index, heart rate, blood pressure, glycated hemoglobin, urinary albumin, serum creatinine, blood urea nitrogen, cystatin C, calculated glomerular filtration rate, total cholesterol, low density lipoprotein cholesterol, high density lipoprotein cholesterol, triglycerides and fasting blood glucose were recorded.2. Inclusion criteria(1) Subject is a male or female and before the study SCr≥1.7mg/dL(150umol/L) for male and SCr≥1.5mg/dL(150umol/L) for female,or eGFR≤50mL/min/1.73m2 and eGFR≥30mL/min/1.73m2 by MDRD formula.(2) Diabetes (typeⅠor TypeⅡ), more than lyear with subcutaneous insulin and oral hypoglycemic agents.(3) 18+years of age(4) Subject agrees not to participate in a conception process and to use of contraception as specified in the protocol.3. Exclusion criteria(1) Subject with serious disease, acute renal failure, kidney transplant, end stage renal disease dialysis line, severe hepatic insufficiency, and congestive heart failure symptoms(2) Pregnancy and breast feeding(3) Subject had used use of metformin the day before 3 days to 7 days of the study and other exclusion exceptions.4. Grouping and methodsThey were randomly divided into two groups:①saline hydration group (n=39), which received intravenous 0.9% NaCl solution at a rate of 1 ml/kg/h for 12 hours before and after contrast media administration for multidetector-row helical computerized tomography(MDCT). The quantity of fluid was adjusted according to body weight and cardiac function. At least two liters the urine volume of 24h were required for sufficient hydration,①conventional therapy group, which received no additional water and fluid therapy.5. Outcome measuresAll patients received non-ionic iso-osmolar contrast medium(iodixanol 320 mg /ml)and their serum creatinine (SCr) just before and after 48 hours,72 hours,168 hours of administration were recorded and analyzed.6. Serious adverse eventsUremia or death due to rapid deterioration of kidney function7. Statistical analysisData are presented as mean x±s. Characteristics of patients between groups were compared using single analysis of variance. For all analyses an alpha of 0.05 was used to define statistical significance.Results1. Serum creatinine levelsThe baseline of SCr in saline hydration group was 160.9±62.7umol/L. After 48 hours,72 h and 168 hours of non-ionic iso-osmolar contrast medium administration, the SCr was 145.8±78.7umol/L、143.1±47.6umol/L、153.8±59.8umol/L, respectively.There was no difference among them(P>0.05). The baseline of SCr in conventional therapy group was 180.3±91.4umol/L. After 48 hours,72 h and 168 hours of non-ionic iso-osmolar contrast medium administration, the SCr was 145.8±78.7umol/L、143.1±47.6umol/L、153.8±59.8umol/L, respectively. The SCr shows no difference before and after administration in the conventional therapy group, either (P>0.05).2. Incidence of CINThe incidence of CIN was lower in hydration group than that in conventional therapy group(OV17.9%,P<0.05)3. Serious adverse eventsThere was no one case of uremia or death.Conclusion1. The incidence of CIN is lowered when saline hydration is used.2. The incidence of contrast-induced nephropathy for high-risk patients can be reduced through the selection of contrast agent formulation and the adjustment dose of contrast medium.

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