The nephrotoxicity of contrasts in coronary artery intervention treatment:a Meta analysis
Objective To assess the nephrotoxicity of isotonic contrast media compared with low-osmolar contrast media in percutaneous coronary interventioa Methods Randomized controlled trials(RCTs) of isotonic contrast medium or low osmolar nonionic contrast medium in percutaneous coronary intervention were s...
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| Main Authors: | , , , |
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| Format: | Article |
| Language: | zho |
| Published: |
Editorial Department of Journal of Clinical Nephrology
2015-01-01
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| Series: | Linchuang shenzangbing zazhi |
| Subjects: | |
| Online Access: | http://www.lcszb.com/thesisDetails?columnId=57920601&Fpath=home&index=0 |
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| Summary: | Objective To assess the nephrotoxicity of isotonic contrast media compared with low-osmolar contrast media in percutaneous coronary interventioa Methods Randomized controlled trials(RCTs) of isotonic contrast medium or low osmolar nonionic contrast medium in percutaneous coronary intervention were searched in the database of CENTRAL,EMbase,PubMed,CNKI,Wanfang,VIP,CBM from their start year to January 2014.The literature references were searched by hand at the same time.Screening and information extraction were done by two researchers independently according to the inclusion and exclusion criteria.Review Manager(version 5.2) of the Cochrane collaboration was used in data analysis.Results Seven RCTs were identified for analysis of aggregated summary data on 2 677 patients.In 6 studies the increased serum creatinine more than 25%of the baseline levels was used as diagnostic criteria of CIN,and there was significant difference in the CIN incidence between the isotonic contrast medium and low osmolar nonionic contrast medium[RR = 0.57,95% CI(0.38~0.84),P = 0.005].In 7 studies the increased serum creatinine more than 44 μmol/L(0.5 mg/dl) was used as diagnostic criteria,and the incidence of CIN showed significant difference between the isotonic contrast medium and low osmolar nonionic contrast medium[RR = 0.65,95% CI(0.43—0.98),P = 0.04].There was no significant difference in the incidence of CIN among 5 trials in patients with the average age ≥65 years old[RR = 0.66,95% CI(0.40~1.09),P = 0.10].To those patients with the average 60~65 years old,there was no significant difference in the incidence of CIN between the isotonic contrast medium and low osmolar nonionic contrast medium[RR = 0.61,95% CI(0.28~1.32),P = 0.21].In 3 articles including the patients with increased baseline of serum,there was significant difference in the incidence of CIN between the isotonic contrast medium and low osmolar nonionic contrast medium[RR = 0.40,95%CI(0.21 ~0.76),P = 0.006].In 2 studies including the patients with normal serum creatinine,the incidence of CIN between the isotonic contrast medium and low osmolar nonionic contrast medium had no significant difference[RR= 1.14,95% CI(0.39~3.37),P = 0.81].If the dosage of contrast medium was <200 ml,there was no significant difference between the two contrast media[RR = 0.85,95% CI(0.51 ~ 1.43),P = 0.55],but if the dosage was≥200 ml,isotonic contrast medium had lower incidence of CIN than low osmolar nonionic contrast medium[RR= 0.38,95% CI(0.18—0.80),P = 0.01].Conclusions The current evidence indicated that the incidence of CIN caused by isotonic contrast medium is lower than that by low osmolar nonionic contrast medium in coronary artery intervention.However,the osmotic pressure may not be the only determinant mechanism of CIN,especially in old patients.It may be associated with the basic renal function,age,etc.Isotonic contrast agents and lower dosage are recommended for the coronary artery intervention,in order to reduce the incidence of the CIN. |
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| ISSN: | 1671-2390 |