Abstract 13249: Oxygen Preconditioning Prevents Contrast-Induced Nephropathy after Coronary Angiography in Patient of Ischemic Heart Disease
BACKGROUND: Contrast-induced nephropathy (CIN) is reported as one of the independent predictors of long-term mortality in patients with ischemic heart disease undergoing coronary angiography (CAG). Several strategies (infusing 0.9% of saline, N-acetyl cysteine or NaHCO3 etc.) were examined to prevent CIN, however, the effect of these strategies is limited and 5-10% of CIN is still observed after CAG. Oxygen preconditioning is considered to have an potential to prevent kidney injury via protecting endothelial function of afferent glomerular arteriole and/or improving ischemic condition of parenchyma renis. The aim of this study was to assess the impact of oxygen preconditioning in patients undergoing CAG.
METHODS: We randomized 300 patients undergoing CAG to oxygenation group (oxygen administration via nasal cannula; 2L/min of oxygen; FiO2 = 0.28, from 10 minutes before the procedure to the end; n = 150) or control group (n = 150). Continuous infusion of 0.9% of saline (1ml/kg/hr) was started 1hr before the procedure until 24 hours after the procedure. Patient's arterial blood gas included ph, PaO2, PaCO2, Base excess, Hb, Ht, Na, K, Cl, Anion gap, lactate and cystatin C were examined just before and at the end the procedure. The primary end-point was incidence of CIN defined as an increase in serum creatinine concentration ≥ 25% above the baseline level within 48 hours of the administration of intravenous contrast.
RESULTS: There were no differences in patients' characteristics between two groups, including contrast volume, serum creatinine concentration and eGFR. The PaO2 at the baseline was significant higher in the oxygenation group than control group (137.9 ± 43.1 vs. 91.6 ± 14.9 mmHg, P < 0.01). The incidence of CIN was 1% in oxygenation group and 6% in control group (P < 0.05). Interestingly, the effect of oxygenation in preventing CIN was more obvious in patients with chronic kidney disease (eGFR < 60ml/min/1.73m2); CIN rate was 0% in oxygenation group vs. 15% in control group (P <0.01).
CONCLUSION: In patients undergoing CAG, the oxygen preconditioning succeeded to reduce the incidence of CIN and there was no side effect during the procedure. This simple strategy was more beneficial for the patients having CKD.
- © 2011 by American Heart Association, Inc.