Vol 24, No 6 (2017)
Original articles — Clinical cardiology
Published online: 2017-04-10

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Association between prophylactic hydration volume and risk of contrast-induced nephropathy after emergent percutaneous coronary intervention

Tongtao Cui, Jianbin Zhao, Weijie Bei, Hualong Li, Ning Tan, Dengxuan Wu, Kun Wang, Xiaosheng Guo, Yuanhui Liu, Chongyang Duan, Shiqun Chen, Kaiyang Lin, Yong Liu
Pubmed: 28394010
Cardiol J 2017;24(6):660-670.


Background: Intravenous hydration during percutaneous coronary intervention (PCI) significantly reduces the risk of contrast-induced nephropathy (CIN), but there are no well-defined protocols regard¬ing the optimal hydration volume (HV) required to prevent CIN following emergent PCI. Therefore, this study investigates the association between the intravenous HV and CIN after emergent PCI. Methods: 711 patients were prospectively recruited who had underwent emergent PCI with hydration at routine speed and the relationship was investigated between HV or HV to weight ratio (HV/W) and the CIN risk, which was defined as a ≥ 25% or ≥ 0.5 mg/dL increase in serum creatinine levels from baseline within 48–72 h of exposure to the contrast. Results: The overall CIN incidence was 24.7%. Patients in the higher HV quartiles had elevated CIN rates. Multivariate analysis showed that higher HV/W ratios were not associated with a decreased risk (using the HV) of CIN, but they were associated with an increased risk (using the HV/W) of CIN (Q4 vs. Q1: adjusted odds ratio 1.99; 95% confidence interval 1.05–3.74; p = 0.034). A higher HV/W ratio was not significantly associated with a reduced risk of long-term death (all p > 0.05). Conclusions: The data suggests that a higher total HV is not associated with a decreased CIN risk or beneficial long-term prognoses, and that excessive HV may increase the risk of CIN after emergent PCI.

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  1. Aurelio A, Durante A. Contrast-induced nephropathy in percutaneous coronary interventions: pathogenesis, risk factors, outcome, prevention and treatment. Cardiology. 2014; 128(1): 62–72.
  2. McCullough PA. Contrast-induced acute kidney injury. J Am Coll Cardiol. 2008; 51(15): 1419–1428.
  3. Marenzi G, Lauri G, Assanelli E, et al. Contrast-induced nephropathy in patients undergoing primary angioplasty for acute myocardial infarction. J Am Coll Cardiol. 2004; 44(9): 1780–1785.
  4. O'Gara PT, Kushner FG, Ascheim DD, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: Executive summary. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013; 61(4): e78–e140.
  5. Cecere N, Jadoul M, Labriola L. Intravenous hydration (with or without rosuvastatin) should remain the cornerstone of the prevention of contrast-induced acute kidney injury in patients with diabetes and chronic kidney disease. J Am Coll Cardiol. 2014; 64(3): 332.
  6. Jurado-Román A, Hernández-Hernández F, García-Tejada J, et al. Role of hydration in contrast-induced nephropathy in patients who underwent primary percutaneous coronary intervention. Am J Cardiol. 2015; 115(9): 1174–1178.
  7. Maioli M, Toso A, Leoncini M, et al. Effects of hydration in contrast-induced acute kidney injury after primary angioplasty: a randomized, controlled trial. Circ Cardiovasc Interv. 2011; 4(5): 456–462.
  8. Manari A, Magnavacchi P, Puggioni E, et al. Acute kidney injury after primary angioplasty: effect of different hydration treatments. J Cardiovasc Med (Hagerstown). 2014; 15(1): 60–67.
  9. Liu Y, Chen JY, Tan N, et al. Safe limits of contrast vary with hydration volume for prevention of contrast-induced nephropathy after coronary angiography among patients with a relatively low risk of contrast-induced nephropathy. Circ Cardiovasc Interv. 2015; 8(6).
  10. Stacul F, van der Molen AJ, Reimer P, et al. Contrast Media Safety Committee of European Society of Urogenital Radiology (ESUR). Contrast induced nephropathy: updated ESUR Contrast Media Safety Committee guidelines. Eur Radiol. 2011; 21(12): 2527–2541.
  11. Hamm CW, Bassand JP, Agewall S, et al. ESC Committee for Practice Guidelines. ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: The Task Force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2011; 32(23): 2999–3054.
  12. Wright RS, Anderson JL, Adams CD, et al. 2011 ACCF/AHA focused update of the Guidelines for the Management of Patients with Unstable Angina/Non-ST-Elevation Myocardial Infarction (updating the 2007 guideline): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines developed in collaboration with the American College of Emergency Physicians, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol. 2011; 57(19): 1920–1959.
  13. Xun L, Cheng W, Hua T, et al. Assessing glomerular filtration rate (GFR) in elderly Chinese patients with chronic kidney disease (CKD): a comparison of various predictive equations. Arch Gerontol Geriatr. 2010; 51(1): 13–20.
  14. Ivanes F, Isorni MA, Halimi JM, et al. Predictive factors of contrast-induced nephropathy in patients undergoing primary coronary angioplasty. Arch Cardiovasc Dis. 2014; 107(8-9): 424–432.
  15. Barrett BJ, Parfrey PS. Clinical practice. Preventing nephropathy induced by contrast medium. N Engl J Med. 2006; 354(4): 379–386.
  16. Moriyama N, Ishihara M, Noguchi T, et al. Admission hyperglycemia is an independent predictor of acute kidney injury in patients with acute myocardial infarction. Circ J. 2014; 78(6): 1475–1480.
  17. R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. 2014. http://www.R-project.org/.
  18. Weisbord SD, Palevsky PM. Prevention of contrast-induced nephropathy with volume expansion. Clin J Am Soc Nephrol. 2008; 3(1): 273–280.
  19. Torigoe K, Tamura A, Watanabe T, et al. 20-Hour preprocedural hydration is not superior to 5-hour preprocedural hydration in the prevention of contrast-induced increases in serum creatinine and cystatin C. Int J Cardiol. 2013; 167(5): 2200–2203.
  20. Koc F, Ozdemir K, Kaya MG, et al. Intravenous N-acetylcysteine plus high-dose hydration versus high-dose hydration and standard hydration for the prevention of contrast-induced nephropathy: CASIS — a multicenter prospective controlled trial. Int J Cardiol. 2012; 155(3): 418–423.
  21. Briguori C, Condorelli G. Hydration in contrast-induced acute kidney injury. Lancet. 2014; 383: 1786–1788.
  22. Romano G, Briguori C, Quintavalle C, et al. Contrast agents and renal cell apoptosis. Eur Heart J. 2008; 29(20): 2569–2576.
  23. House AA, Anand I, Bellomo R, et al. Acute Dialysis Quality Initiative Consensus Group. Definition and classification of cardio-renal syndromes: workgroup statements from the 7th ADQI Consensus Conference. Nephrol Dial Transplant. 2010; 25(5): 1416–1420.
  24. Ronco C, Cicoira M, McCullough PA. Cardiorenal syndrome type 1: Pathophysiological crosstalk leading to combined heart and kidney dysfunction in the setting of acutely decompensated heart failure. J Am Coll Cardiol. 2012; 60(12): 1031–1042.
  25. Dussol B, Morange S, Loundoun A, et al. A randomized trial of saline hydration to prevent contrast nephropathy in chronic renal failure patients. Nephrol Dial Transplant. 2006; 21(8): 2120–2126.
  26. Solomon R, Werner C, Mann D, et al. Effects of saline, mannitol, and furosemide on acute decreases in renal function induced by radiocontrast agents. N Engl J Med. 1994; 331(21): 1416–1420.
  27. Majumdar SR, Kjellstrand CM, Tymchak WJ, et al. Forced euvolemic diuresis with mannitol and furosemide for prevention of contrast-induced nephropathy in patients with CKD undergoing coronary angiography: a randomized controlled trial. Am J Kidney Dis. 2009; 54(4): 602–609.
  28. Briguori C, Visconti G, Focaccio A, et al. REMEDIAL II Investigators. Renal insufficiency after contrast media administration trial II (REMEDIAL II): RenalGuard System in high-risk patients for contrast-induced acute kidney injury. Circulation. 2011; 124(11): 1260–1269.
  29. Brar SS, Aharonian V, Mansukhani P, et al. Haemodynamic-guided fluid administration for the prevention of contrast-induced acute kidney injury: the POSEIDON randomised controlled trial. Lancet. 2014; 383(9931): 1814–1823.
  30. Seeliger E, Becker K, Ladwig M, et al. Up to 50-fold increase in urine viscosity with iso-osmolar contrast media in the rat. Radiology. 2010; 256(2): 406–414.
  31. Seeliger E, Sendeski M, Rihal CS, et al. Contrast-induced kidney injury: mechanisms, risk factors, and prevention. Eur Heart J. 2012; 33(16): 2007–2015.