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Acute kidney injury after primary angioplasty: effect of different hydration treatments

Antonio Manari1, Paolo Magnavacchi, Enrico Puggioni

  • 1aCardiologia Interventistica Azienda Ospedaliera-IRCCS S. Maria Nuova, Reggio Emilia bCardiologia, Nuovo Ospedale Civile S. Agostino-Estense, Modena cDipartimento di Cardiologia, Ospedali del Tigullio, Lavagna dDivisione di Cardiologia, Ospedale Maggiore, Parma eDivisione di Nefrologia, Dipartimento di Medicina Interna, Università di Parma fIBIS Informatica, Milan gIstituto di Cardiologia, Azienda Ospedaliera-Universitaria S. Anna, Ferrara, Italy.

Journal of Cardiovascular Medicine (Hagerstown, Md.)
|February 7, 2014
PubMed

Insights

High-volume hydration with saline or bicarbonate did not prevent contrast-induced acute kidney injury (CI-AKI) in ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PPCI). Higher hydration volumes were linked to increased short-term mortality.

Area of Science:

  • Cardiology
  • Nephrology
  • Interventional Cardiology

Background:

  • Contrast-induced acute kidney injury (CI-AKI) is a significant complication in patients with ST-elevation myocardial infarction (STEMI).
  • Hydration protocols are standard practice to mitigate CI-AKI risk during primary percutaneous coronary intervention (PPCI).
  • Optimal hydration strategies, including fluid type and volume, remain under investigation.

Purpose of the Study:

  • To evaluate the efficacy of different hydration protocols (normal saline vs. sodium bicarbonate, standard vs. high-dose) in preventing CI-AKI.
  • To assess the impact of these protocols on short-term and 1-year mortality in STEMI patients undergoing PPCI.

Main Methods:

  • A randomized trial involving 592 STEMI patients treated with PPCI across 5 Italian centers.
  • Patients received either standard or high-dose infusions of normal saline or sodium bicarbonate.
  • Hydration was initiated before contrast administration and continued for 12 hours post-procedure.

Main Results:

  • The overall incidence of CI-AKI was 18.1%, with no significant difference among the hydration groups.
  • Independent risk factors for CI-AKI included shock, age, low ejection fraction, and elevated baseline serum creatinine.
  • High-volume hydration was associated with higher short-term mortality, while age, shock, and CI-AKI predicted 1-year mortality.

Conclusions:

  • High-volume hydration with normal saline or sodium bicarbonate does not offer a significant advantage in preventing CI-AKI in STEMI patients undergoing PPCI.
  • Clinicians should carefully consider hydration volumes due to potential associations with increased short-term mortality.
Abstract

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