Advertisement

Role of Hydration in Contrast-Induced Nephropathy in Patients Who Underwent Primary Percutaneous Coronary Intervention

Published:February 11, 2015DOI:https://doi.org/10.1016/j.amjcard.2015.02.004
      To investigate the role of hydration to prevent contrast-induced nephropathy (CIN) in patients with ST-segment elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PPCI), we prospectively included 408 consecutive patients who were randomly assigned to receive either hydration with isotonic saline (1 ml/kg/h since the beginning of the procedure and for 24 hours after it: NS+ group) or not (NS− group). All patients received an iso-osmolar nonionic contrast medium. The primary end point was the development of CIN: ≥25% or ≥0.5 mg/dl increase in serum creatinine within 3 days after the procedure. CIN was observed in 14% of patients: 21% in the NS− group and 11% in the NS+ group (p = 0.016). CIN was significantly associated with death (15.2% vs 2.8%; p <0.0001) and need for dialysis (13.4% vs 0%; p <0.0001). In multivariate analysis, the only predictors of CIN were hydration (OR = 0.29 [0.14 to 0.66]; p = 0.003) and the hemoglobin before the procedure (OR = 0.69 [0.59 to 0.88]; p <0.0001). In conclusion, intravenous saline hydration during PPCI reduced the risk of CIN to 48%. Patients with CIN had increased mortality and need for dialysis. Given the higher incidence of CIN in emergent procedures, and its morbidity and mortality, preventive hydration should be mandatory in them unless contraindicated.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Chong E.
        • Poh K.K.
        • Liang S.
        • Soon C.Y.
        • Tan H.C.
        Comparison of risks and clinical predictors of contrast-induced nephropathy in patients undergoing emergency versus nonemergency percutaneous coronary interventions.
        J Interv Cardiol. 2010; 23: 451-459
        • Maioli M.
        • Toso A.
        • Leoncini M.
        • Micheletti C.
        • Bellandi F.
        Effects of hydration in contrast-induced acute kidney injury after primary angioplasty. A randomized, controlled trial.
        Circ Cardiovasc Interv. 2011; 4: 456-462
        • Wijns W.
        • Kolh P.
        • Danchin N.
        • Di Mario C.
        • Falk V.
        • Folliguet T.
        • Garg S.
        • Huber K.
        • James S.
        • Knuuti J.
        • López-Sendón J.
        • Marco J.
        • Menicanti L.
        • Ostojic M.
        • Piepoli M.F.
        • Pirlet C.
        • Pomar J.L.
        • Reifart N.
        • Ribichini F.L.
        • Schalij M.J.
        • Sergeant P.
        • Serruys P.W.
        • Silber S.
        • Uva M.S.
        • Taggart T.
        Guidelines on myocardial revascularization.
        Eur Heart J. 2010; 31: 2501-2555
        • Thomsen H.S.
        European Society of Urogenital Radiology (ESUR) guidelines on the safe use of iodinated contrast media.
        Eur J Radiol. 2006; 60: 307-313
        • National Kidney Foundation
        K/DOQJ. Clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification.
        Am J Kidney Dis. 2002; 39: 51-237
        • Mehran R.
        • Aymong E.D.
        • Nikolsky E.
        • Lasic Z.
        • Iakovou I.
        • Fahy M.
        • Mintz G.S.
        • Lansky A.J.
        • Moses J.W.
        • Stone G.W.
        • Leon M.B.
        • Dangas G.
        A simple risk score for prediction of contrast-induced nephropathy after percutaneous coronary intervention.
        J Am Coll Cardiol. 2004; 44: 1393-1399
        • Laskey W.K.
        • Jenkins C.
        • Selzer F.
        • Marroquin O.C.
        • Wilensky R.L.
        • Glaser R.
        • Cohen H.A.
        • Holmes D.R.
        Volume-to-creatinine clearance ratio: a pharmaco-kinetically based risk factor for prediction of early creatinine increase after percutaneous coronary intervention.
        J Am Coll Cardiol. 2007; 50: 584-590
        • Marenzi G.
        • Lauri G.
        • Assanelli E.
        • Campodonico J.
        • De Metrio M.
        • Marana I.
        • Grazi M.
        • Veglia F.
        • Bartorelli A.L.
        Contrast-induced nephropathy in patients undergoing primary angioplasty for acute myocardial infarction.
        J Am Coll Cardiol. 2004; 44: 1780-1785
        • Rihal C.S.
        • Textor S.C.
        • Grill D.E.
        • Berger P.B.
        • Ting H.H.
        • Best P.J.
        • Singh M.
        • Bell M.R.
        • Barsness G.W.
        • Mathew V.
        • Garratt K.N.
        • Holmes D.R.
        Incidence and prognostic importance of acute renal failure after percutaneous coronary intervention.
        Circulation. 2002; 105: 2259-2264
        • Gurm H.S.
        • Seth M.
        • Kooiman J.
        • Share D.
        A novel tool for reliable and accurate prediction of renal complications in patients undergoing percutaneous coronary intervention.
        J Am Coll Cardiol. 2013; 61: 2242-2248
        • Brar S.S.
        • Hiremath S.
        • Dangas G.
        • Mehran R.
        • Brar S.K.
        • Leon M.B.
        Sodium bicarbonate for the prevention of contrast induced-acute kidney injury: a systematic review and meta-analysis.
        Clin J Am Soc Nephrol. 2009; 4: 1584-1592
        • Zoungas S.
        • Ninomiya T.
        • Huxley R.
        • Cass A.
        • Jardine M.
        • Gallagher M.
        • Patel A.
        • Vasheghani-Farahani A.
        • Sadigh G.
        • Perkovic V.
        Systematic review: sodium bicarbonate treatment regimens for the prevention of contrast-induced nephropathy.
        Ann Intern Med. 2009; 151: 631-638
        • Maioli M.
        • Toso A.
        • Leoncini M.
        • Gallopin M.
        • Tedeschi D.
        • Micheletti C.
        • Bellandi F.
        Sodium bicarbonate versus saline for the prevention of contrast-induced nephropathy in patients with renal dysfunction undergoing coronary angiography or intervention.
        J Am Coll Cardiol. 2008; 52: 599-604
        • Brar S.S.
        • Shen A.Y.
        • Jorgensen M.B.
        • Kotlewski A.
        • Aharonian V.J.
        • Desai N.
        • Ree M.
        • Shah A.I.
        • Burchette R.J.
        Sodium bicarbonate vs sodium chloride for the prevention of contrast medium-induced nephropathy in patients undergoing coronary angiography: a randomized trial.
        JAMA. 2008; 300: 1038-1046
        • Marenzi G.
        • Assanelli E.
        • Marana I.
        • Lauri G.
        • Campodonico J.
        • Grazi M.
        • De Metrio M.
        • Galli S.
        • Fabbiocchi F.
        • Montorsi P.
        • Veglia F.
        • Bartorelli A.L.
        N-acetylcysteine and contrast-induced nephropathy in primary angio-plasty.
        N Engl J Med. 2006; 354: 2773-2782
        • Merten G.J.
        • Burgess W.P.
        • Gray L.V.
        • Holleman J.H.
        • Roush T.S.
        • Kowalchuck G.J.
        • Bersin R.M.
        • Moore A.V.
        • Simonton III, C.A.
        • Rittase R.A.
        • Norton H.J.
        • Kennedy T.P.
        Prevention of contrast-induced nephropathy with sodium bicarbonate.
        JAMA. 2004; 291: 2328-2334
        • Masuda M.
        • Yamada T.
        • Mine T.
        • Morita T.
        • Tamaki S.
        • Tsukamoto Y.
        • Okuda K.
        • Iwasaki Y.
        • Hori M.
        • Fukunami M.
        Comparison of usefulness of sodium bicarbonate versus sodium chloride to prevent contrast-induced nephropathy in patients undergoing an emergent coronary procedure.
        Am J Cardiol. 2007; 100: 781-786
        • Recio-Mayoral A.
        • Chaparro M.
        • Prado B.
        • Cozar R.
        • Mendez I.
        • Banerjee D.
        • Kaski J.C.
        • Cubero J.
        • Cruz J.M.
        The reno-protective effect of hydration with sodium bicarbonate plus N-acetylcysteine in patients undergoing emergency percutaneous coronary intervention. The RENO study.
        J Am Coll Cardiol. 2007; 49: 1283-1288
        • Thayssen P.
        • Lassen J.F.
        • Jensen S.E.
        • Hansen K.N.
        • Hansen H.S.
        • Christiansen E.H.
        • Junker A.
        • Ravkilde J.
        • Thuesen L.
        • Veien K.T.
        • Jensen L.O.
        Prevention of contrast-induced nephropathy with n-acetylcysteine or sodium bicarbonate in patients with ST-segment–myocardial infarction a prospective, randomized, open-labeled trial.
        Circ Cardiovasc Interv. 2014; 7: 216-224