Preventive effect of hemodialysis filtration on acute kidney injury caused by contrast in patients with coronary heart disease with renal insufficiency

Han Peitian; Bai Xuejiao; Du Binbin; Jia Huiyu

doi:10.3969/j.issn.1671-6450.2025.01.011

Abstract：Objective To explore the effect of applying hemodialysis filtration combined with hydration therapy to prevent contrast-induced acute kidney injury(CI-AKI)after percutaneous coronary intervention(PCI)in coronary heart dis-ease patients with diabetes mellitus and mild-to-moderate renal insufficiency.Methods Sixty cases of coronary heart dis-ease patients with combined diabetes mellitus and mild-to-moderate chronic renal insufficiency who underwent PCI treat-ment admitted to the Second Hospital Affiliated to Hebei North College from January 2018 to December 2020 were selected,and divided into 30 cases each in the hydration group and the hydration+blood purification group according to the method of randomized numerical table,and the hydration group was given the intervention of the standard hydration treatment method,and the standard hydration treatment method was given to the hydration group.The hydration+blood purifica-tion group was given standard hydration therapy+hemodialysis filtration intervention.The renal function indexes[blood creatinine(SCr),creatinine clearance(CCr),serum cystatin C(Cys-C)and retinol-binding protein(RBP),blood urea nitrogen(BUN),and serum β2-microglobulin(β2-MG)]were measured in the two groups before and 48 and 72 h after PCI,and the estimated glomerular filtration rate(eGFR)was calculated to assess the changes of renal function before and after exposure to the contrast agent.Changes in renal function were evaluated before and after exposure to contrast media.We also deter-mined the levels of related inflammatory factors.Results After the intervention,the levels of SCr,Cys-C,RBP and BUN in the hydration group were higher than those in the preoperative period at 48 and 72 h after PCI,and the difference was sta-tistically significant(P＜0.01),while the levels of CCr and eGFR were lower than those in the preoperative period(F/P=59.018/＜0.001,7.028/0.002);β 2-MG levels tended to increase compared with preoperative levels,but the difference was not statistically significant(F/P=1.774/0.176);IL-6,IL-10,TFN-α,and CRP levels decreased compared with preoperative levels(P＜0.01),and INF-y levels increased(F/P=154.350/＜0.001).The levels of SCr,RBP,BUN,and β 2-MG were lower in the hydration+blood purification group at 48 and 72 h after PCI compared with the preoperative period(P＜0.01)and lower than those in the hydration group at the corresponding time points(P＜0.05 or P＜0.01);CCr levels were elevated compared to preoperative(F/P=121.038/＜0.001)and were higher than those in the hydration group at the corresponding time point(P＜0.01);Cys-C levels were not statistically different from preoperative(F/P=0.137/0.872),but were lower than those in the hydration group at the corresponding postoperative time point(P＜0.01);eGFR levels were elevated compared with preoper-ative(F/P=329.348/＜0.001),and higher than the corresponding time-point hydration group(P＜0.01);IL-6,IL-10,TNF-α,and CRP levels were lower than preoperative(P＜0.01)and lower than the corresponding time-point hydration group(P＜0.01);INF-y level was elevated(F/P=704.002/＜0.001),and higher than the corresponding time point hydration group(P＜0.01).Conclusion The application of hemodialysis filtration combined with hydration therapy to prevent CI-AKI after PCI in coronary artery disease patients with diabetes mellitus with mild to moderate renal insufficiency has good effect,which can effectively reduce the renal injury by contrast agent and has better effect than hydration therapy alone.