Abstract 16549: Prevention of Contrast-Induced Nephropathy by Oxygen Preconditioning in Patients With Impaired Renal Function
Introduction: We previously reported the preventive effect of periprocedural oxygenation on contrast-induced nephropathy (CIN) in the Option CIN study.
Hypothesis: In the present study, we sought to determine whether this simple preventive strategy works among patients with pre-existing renal dysfunction, in whom CIN occurrence is more prevalent.
Methods: The Extended-Option CIN study included 200 consecutive patients with impaired renal function (eGFR < 60 mL/min/1.73 m2) undergoing elective cardiovascular angiography and randomly assigned them 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 for 10 min before exposure to the contrast medium. The primary endpoint was CIN incidence, defined as an increase in serum creatinine levels of ≥25% or 0.5 mg/dL above baseline levels within 48 h of exposure.
Results: In the oxygen preconditioning group, PaO2 was significantly higher (130 ± 24 vs. 88 ± 12 mmHg, P < 0.001), while the levels of PCO2, HCO3–, base excess, and lactate levels were similar. CIN incidence was lower (2% vs. 11%, OR 0.17, 95% CI 0.04-0.77, P < 0.001) compared with the control group. In univariate analysis comorbidity with anemia (OR 3.87, CI 1.18-12.74, P = 0.02 ) and low PaO2 levels <100mmHg (OR 6.89, CI 1.49-31.95, P < 0.01) were associated with CIN incidence. Multivariate analysis identified PaO2 <100 mmHg was the only significant predictor of CIN (OR 6.89, 95% CI 1.49-31.95, P < 0.01).
Conclusions: Oxygen preconditioning decreased CIN incidence in patients with decreased eGFR. Oxygenation, a simple, non-pharmacologial preventive strategy, may be widely applicable when using contrast media in patients with impaired renal function, from noninvasive angiography to emergency cauterization setting.
Author Disclosures: H. Sekiguchi: None. Y. Ajiro: None. Y. Uchida: None. K. Iwade: None. N. Tanaka: None. K. Shimamoto: None. Y. Tsurumi: None. M. Kawana: None. N. Hagiwara: None.
- © 2014 by American Heart Association, Inc.