Objectives: 目的

To test whether hydration with bicarbonate rather than isotonic sodium chloride reduces the risk of contrast-associated acute kidney injury in critically ill patients.

相比于等渗盐水，检测用碳酸氢盐水化是否会降低危重患者中造影剂相关的急性肾损伤。

Design：设计

Prospective, double-blind, multicenter, randomized con-trolled study.

前瞻性、双盲、多中心、随机对照实验。

Setting：地点

Three French ICUs.

法国三家ICU

Patients: 患者

Critically ill patients with stable renal function (n = 307) who received intravascular contrast media.

接受静脉造影剂的肾功能稳定的危重患者(307人)

Interventions: 干预措施

Hydration with 0.9% sodium chloride or 1.4% sodium bicarbonate administered with the same infusion protocol: 3 mL/kg during 1 hour before and 1 mL/kg/hr during 6 hours after contrast medium exposure.

采用同样的灌注方法分别用0.9%氯化钠或者1.4%碳酸氢钠水化：使用造影剂1小时前用3ml/kg水化，使用造影剂后6小时内用1ml/kg/hr。

Measurements and Main Results: 测量和主要结果

The primary endpoint was the development of contrast-associated acute kidney injury, as defined by the Acute Kidney Injury Network criteria, 72 hours after contrast exposure. Patients randomized to the bicarbonate group (n = 151) showed a higher urinary pH at the end of the infusion than patients randomized to the saline group (n = 156) (6.7 ± 2.1 vs 6.2 ± 1.8, respectively; p < 0.0001). The frequency of contrast-associated acute kidney injury was similar in both groups: 52 patients (33.3%) in the saline group and 53 patients (35.1%) in the bicarbonate group (absolute risk difference, –1.8%; 95% CI [–12.3% to 8.9%]; p = 0.81). The need for renal replacement therapy (five [3.2%] and six [3.9%] patients; p = 0.77), ICU length of stay (24.7 ± 22.9 and 23 ± 23.8 d; p = 0.52), and mortality (25 [16.0%] and 24 [15.9%] patients; p > 0.99) were also similar between the saline and bicarbonate groups, respectively.

主要终点是应用造影剂后72小时所发生的造影剂相关的急性肾损伤，按照急性肾损伤的网络标准。相比于氯化钠组(156人)，随机分配到碳酸氢钠组(151人)的患者在灌注后具有更高的尿PH值(6.7 ± 2.1 vs. 6.2 ± 1.8, p < 0.0001) 。急性肾损伤发生的概率在两组是相似的(氯化钠组52人，占33.3%;碳酸氢钠组53人，占35.1%;绝对风险差，–1.8%; 95% CI [–12.3% -8.9%];p = 0.81)。需要肾脏替代治疗(5例 [3.2%] vs. 6例 [3.9%] ; p = 0.77) 和ICU住院时间(24.7 ± 22.9 vs. 23 ± 23.8天; p = 0.52 )及死亡率(25 例[16.0%] vs. 24例 [15.9%] ; p > 0.99 )在两组中也是相似的。

Conclusions: 总结

Except for urinary pH, none of the outcomes differed between the two groups. Among ICU patients with stable renal function, the benefit of using sodium bicarbonate rather than iso-tonic sodium chloride for preventing contrast-associated acute kid-ney injury is marginal, if any.

除了尿液PH，两组其他结局均无明显差异。肾脏功能稳定的ICU患者，相比于氯化钠水化，采用碳酸氢钠水化来预防造影剂相关的急性肾损伤的优势微乎其微。