Abstract 12235: Oxygenation Prevents Contrast-induced Nephropathy via Nitric Oxide Induction
Background: Direct toxicity of contrast media and subsequent renal ischemia are involved in the pathogenesis of contrast-induced nephropathy (CIN). Our hypothesis was that sufficient oxygenation before contrast medium administration may mitigate kidney injury and reduce the incidence of CIN. This study was designed to examine the protective effect of oxygenation on CIN in patients with chronic kidney disease (CKD).
Methods: We studied 200 consecutive CKD patients with stage III or worse who underwent elective cardiovascular angiography. Patients were randomly assigned to either an oxygen preconditioning group (n = 100) or a control group (n = 100). Oxygen preconditioning was achieved by administering 2 L/min of pure oxygen 15 min before exposure to contrast medium. All patients received intravenous hydration with 0.9% isotonic saline as a standard preventive measure. The primary end-point was the incidence of CIN defined as an increase in serum creatinine concentration ≥ 25% or 0.5mg/dl above the baseline level at 2days after angiography. Plasma nitric oxide metabolities (NOx), which is known to elevate in acute renal injury, was also evaluated at baseline and at the end of the procedure.
Results: Oxygen preconditioning achieved higher PaO2 compared to the control group (130 ± 24 vs. 88 ± 12 mmHg, P < 0.001), which were maintained at the end of the procedure (127 ± 26 vs. 84 ± 15 mmHg, P < 0.001). The incidence of CIN was significantly lower in the oxygen group (2% vs. 11%, OR: 0.17, [95% CI 0.04-0.77], P < 0.001). Multivariate analysis revealed that PaO2 < 100 mmHg (OR 6.4, P = 0.02) was the only independent predictor of CIN. Significantly greater reduction in NOx was observed in the oxygen preconditioning group than that in the control group (9.4 ± 7.2 vs. 6.0 ± 4.6 mmHg, P < 0.05)
Conclusions: A simple preventive strategy, oxygen preconditioning, thus reduced the incidence of CIN, accompanied with reduction in NOx. in patients with CKD.
- © 2012 by American Heart Association, Inc.