Effects Of Different Contrast Agents On Renal Function In Patients Undergoing Coronary Intervention At High Altitude

Objective: The purpose of this study was to observe the effects of the low-osmolar contrast medium iohexol injection(Omnipaque)and iso-osmolar contrast medium iodixanol injection(Visipaque)as well as different doses of contrast agent on renal function in patients undergoing coronary intervention at high altitude(1500m-3500 m above sea level).Methods: We recruited patients from December 2017 to December 2018,120 patients who were hospitalized in Cardiovascular Medicine Department of Affiliated Hospital of Qinghai University or migrated to high altitude areas for more than 20 years were randomly selected to receive coronary angiography(CAG)and/or percutaneous coronary intervention(PCI)because of the need for diagnosis and treatment of coronary heart disease.Data of the subjects were collected: age,sex,body mass index(BMI),history of hypertension and diabetes mellitus,TG,TC,LDL-C,Hg,HSCRP within 24 hours of admission,serum creatinine(SCr),urea nitrogen(Bun),uric acid(umo)48-72 hours before and after operation.L/L,Cystatin C(CysC),dosage of contrast agent and the use of ACEI/ARB and other drugs.Serum creatinine clearance rate(CCr)was calculated according to the formula.Statistical analysis was used to investigate the effects of different types of contrast agents and different doses of contrast agents on the renal function of the subjects.The diagnostic criteria for contrast agent-induced acute kidney injury(CI-AKI)were as follows: renal function was impaired 48-72 hours after using contrast agent,i.e.serum creatinine increased by 25% at baseline level or absolute serum creatinine increased by 44.2 umol/L(0.5 mg/dl),excluding other pathogenic factors.Results: 1.There were 17 cases of CI-AKI in hypotonic group and isotonic group(14.17%),14 cases in hypotonic group and 3 cases in isotonic group(20.59% and 5.77%,P=0.021),respectively.The incidence of CI-AKI in hypotonic group was higher than that in isotonic group(P=0.021).The Scr of 48-72 hours after operation in hypotonic group and isotonic group was significantly higher than that before operation,and Ccr was significantly lower than that before operation.There was significant difference between the two groups(P < 0.05).Both contrast agents had the effect of kidney injury.The Scr of 48-72 hours after operation in hypotonic group was higher than that in isotonic group,and the Ccr was significantly lower than that in isotonic group,and there was significant difference between the two groups(P < 0.05).The safety of isotonic contrast agent is higher in high altitude area.2.There were 17 cases of CI-AKI in group A(< 200 ml group)and group B(> 200 ml group),6 cases in group A and 11 cases in group B,respectively.The incidence of CIAKI was 8.33% and 22.92%.There were significant differences between the two groups(P=0.025).The higher the dosage of contrast agent,the higher the incidence of CI-AKI.The higher the Sc r was,the lower the CCr was in group B than that in group A 48-72 hours after operation.(P < 0.05),the greater the dose of contrast agent,the greater the damage to renal function.Conclusion: 1.For patients undergoing coronary intervention at high altitude,hypoosmotic contrast agent iohexol and isoosmotic contrast agent ioxanol have renal injury effects,but isoosmotic contrast agent ioxanol has less damage,the incidence of acute contrast agent renal injury is lower,and the safety is higher.2.For patients undergoing coronary intervention at high altitude,the dosage of contrast agent has a significant impact on renal function.The dosage increases,the damage of renal function increases,and the incidence of acute contrast agent renal injury increases.