| Objective To analyse the effect of the two low-osmolaity nonionic contrast medias on renal function and the influencing factors in patients underwent coronary angiography(CAG) with/without percutaneous coronary intervention (PCI),and to study the incidence and risk factors of contrast-induced nephropathy(CIN).Methods The patients undergoing coronary angiography with/without percutaneous coronary intervention in TEDA International Cardiovascular Hospital with complete data and good compliance were enrolled, whose renal function was normal. Either Iopromide (Ultravist) or Iohexol (Omnipaque) were given to all the subjects as low-osmolaity nonionic contrast media. Age, sex, weight, underlying diseases (diabetes, hypertension, heart failure), blood lipids, drug use (including ACEI or ARB drugs, diuretics, CCB drugs, metformin, insulin), the type of contrast media and dose were documented accurately.Serum creatinine (Scr), blood urea nitrogen (BUN) were measured at any time of the three days just before the angiography as well as the1st,3rd,7th and14th day post-procedure, while Creatinine clearance (Ccr) was calculated by applying the Cockcroft-Gault formula, which was widely used in clinic. Clinical features, pre-and post-operative differences of Scr, BUN and Ccr, the rate of contrast-induced nephropathy (CIN) of the two groups were compared in order to analyze age, gender, underlying diseases, type and dose of contrast media and other factors in the role of contrast media upon renal function and the risk factors of CIN.Results (1)Among the546patients,331were male and215were female ranged from34to83years old,while the average age was61.10±9.51years old. Among the patients enrolled,360had hypertension,147had diabetes mellitus,22had heart failure (NYHAⅢ-Ⅳ).106patients had cigarettes smoking history,118patients took ACEI or ARB,25patients took diuretics,87patients took diuretics,32patients took metformin and34patients took insulin. The average Scr before procedure was66.50±14.68umol/L and the average Ccr before procedure was103.71±30.48ml/min. Among the patients enrolled,382patients used Iopromide, while164patiens used Iohexol. The average volume of contrast-media was108.00±67.77ml. There was no significant difference in clinical features of the two groups.(P>0.05).(2) The group which used less than100ml volume of contrast media was composed of363patients, and252of them used Iopromide, while111of them used Iohexol; There are98patients in the greup which volume of contrast media consumed ranged from100ml to200ml, and75of them used Iopromide, while23of them used Iohexol; In the group which used more than200ml volume of contrast media,55patients used Iopromide. while30patiens used Iohexol; No difference was found among the clinical features (age, gender, basic renal function, creatinine clearance, diabetes,etc) of the3groups (P>0.05).(3) No difference was found about the effect of the two contrast medias upon renal function between the two groups(P>0.05); In the patients who used less than100ml and those who used100-200ml contrast media,no significant difference was found between the pre-operation level of Scr,BUN and Ccr and that of the1st,3rd,7th,14th day of post-operation period (P>0.05);In the patients who used more than200ml volume of contrast-media, the level of Scr increased in the3rd post-procedure day, and the difference was significant compared to the level of Scr before coronary intervention procedure (P<0.05); while no difference was found between the level of Scr before coronary intervention procedure and that of the1st,7th, and14th post-procedure day (P>0.05); No difference was found between the level of pre-procedure BUN and that of the1st,3rd,7th and14th post-procedure day (P>0.05); Compared with the level of Ccr before coronary?there was a downtrend after angiography, but difference was only found on the3rd post-procedure day(P<0.05).(4) When the volume of contrast-media was more than200ml,multivariate stepwise regression analysis suggested that age (more than65years old)and diabetes mellitus was the factors that affect the renal function.(5)28patients suffered from CIN. The volume of contrast-media was from175to371ml,while the average age was240.82±36.02ml.19(5.0%) cases of Iopromide group occurred CIN, while9(5.8%) of Iohexol group did, and the total incidence of CIN of the two groups was5.13%There was no significant difference between the incidences of CIN of the two groups (P>0.05);More than65years old was the independent risk factor of CIN.Conclusion Low-osmolaity nonionic contrast media can affect the renal function in patients underwent coronary intervention, which is related to the dose of contrast media, and most of them are reversible; When the contrast agent is over a certain dose range, age and diabetes mellitus become the factors that affect the renal function; Few patients suffered from contrast-induced nephropathy, and the independent risk factor of CIN was more than65years old. |
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