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Association between prophylactic hydration volume and risk of contrast-induced nephropathy after emergent
Tongtao Cui, Jianbin Zhao, Weijie Bei
1Guangdong General Hospital, Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences, Guangdong provincial Key Laboratory of Coronary Disease, School of Medicine, South China University of Technology. liuyongmd@126.com.
Insights
Higher intravenous hydration volumes (HV) did not reduce contrast-induced nephropathy (CIN) risk after emergent percutaneous coronary intervention (PCI). Excessive hydration may even increase CIN risk, suggesting current protocols need re-evaluation for optimal patient outcomes.
Area of Science:
- Cardiology
- Nephrology
- Interventional Cardiology
Background:
- Intravenous hydration is crucial for preventing contrast-induced nephropathy (CIN) after percutaneous coronary intervention (PCI).
- Optimal hydration volume (HV) protocols for emergent PCI remain undefined.
- This study examines the association between intravenous HV and CIN risk following emergent PCI.
Purpose of the Study:
- To investigate the relationship between intravenous hydration volume and the incidence of contrast-induced nephropathy (CIN) after emergent percutaneous coronary intervention (PCI).
- To determine if higher hydration volumes or hydration volume-to-weight ratios are associated with reduced CIN risk or improved long-term outcomes.
Main Methods:
- Prospective recruitment of 711 patients undergoing emergent PCI with routine hydration speed.
- Analysis of the association between hydration volume (HV) and HV to weight ratio (HV/W) with CIN risk.
- CIN defined as a ≥25% or ≥0.5 mg/dL increase in serum creatinine within 48-72 hours post-contrast.
Main Results:
- Overall CIN incidence was 24.7%.
- Higher HV quartiles correlated with increased CIN rates.
- Higher HV/W ratios were associated with an increased risk of CIN (aOR 1.99; 95% CI 1.05-3.74; p=0.034), not a decreased risk.
Conclusions:
- Increased total intravenous hydration volume is not linked to reduced CIN risk or better long-term prognosis after emergent PCI.
- Excessive hydration volume may potentially elevate the risk of CIN in patients undergoing emergent PCI.
- Current hydration protocols warrant re-evaluation to optimize CIN prevention and patient outcomes.
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.