The Impairment On Renal Function Of Different Osmolar Contrast Medias For Patients Undergoing Elective Percutaneous Coronary Intervention

[Objective]With the widespread use of coronary artery angiography/percutaneous coronary intervention, iodinated contrast media would be seen in daily life. Contrast-induced nephropathy, a complication of coronary artery angiography/percutaneous coronary intervention in patients, is a well-established independent predictor of increased in-hospital morbidity and mortality. According to different osmolar, contrast-media was divided into3categories:high-osmolar, low-osmolar and iso-osmolar. Since high-osmolar contrast media has sever adverse effect, low-osmolar and iso-osmolar ones become more and more popular. Even the so-called "low-osmolar contrast media", its osmolality is still much higher than plasma, which could increase the production of reactive oxygen species, enhance inflammatory response in mesangial tissue, disturb the hemodynamics in kidney, all of the above may play roles in the development of contrast-induced nephropathy. Whether iso-osmolar contrast media is superior to low-osmolar ones in the prevention of contrast-induced nephropathy still need to be investigated. In this article, we performed a meta-analysis with several randomized clinical trials comparing different osmolar contrast medias on renal function. We also collected patients’information in our heart center to assess the impairment on renal function of iohexol among patients with mild renal dysfunction undergoing elective percutaneous coronary intervention.[Method]We performed a computerized search to identify relevant free full articles from Web of Science, Cochrane Library and PubMed database with the following key words "contrast-induced nephropathy","contrast media" and "percutaneous coronary intervention". We utilized "Studies and references"、"Data and analyses" as well as "Figures" sections of Review Manager5.0to perform a meta-analysis.PCI Patients’ information was collected from1st Feb2013to20th Mar2013with details on age, sex, baseline MDRD-eGFR, baseline serum creatinine, contrast media type,6h serum creatinine after intervention and24h-72h serum creatinine after intervention. The definition of contrast-induced nephropathy is serum creatinine level increases≥25%from baseline within72h after contrast media administration. We calculated the mean serum creatinine levels before and after interventions using Micro Office2010Excel, also performed two-tail t critical (a=0.05).[Result]The result from meta-analysis revealed iso-osmolar contrast media could not decrease the incidence of contrast media nephropathy (OR=0.86,95%CI [0.71,1.04]); in the subgroup analysis with renal dysfunction patients the result was the same (OR=0.89,95%CI [0.71,1.11]).Only1case in our center suffered from contrast-induced nephropathy, compared with baseline serum creatinine level,6h serum creatinine level after intervention was significantly lower (p<0.05); there was no significant change between24h and baseline serum creatinine level (p=0.10).[Conclusion]Iso-osmolar contrast media cannot effectively decrease the incidence of contrast-induced nephropathy in general patients as well as patients with mild to moderate renal dysfunction; among patients with mild renal dysfunction, using iohexol combined with Ringer’s solution hydration, their serum creatinine would not significantly increase within24h after iohexol administration.