Optimal hydration volume among high-risk patients with advanced congestive heart failure undergoing coronary...

Area of Science:

• Cardiology
• Nephrology
• Critical Care Medicine

Background:

• Advanced congestive heart failure (CHF) poses significant risks during cardiac procedures.
• Contrast-induced acute kidney injury (CI-AKI) and worsening heart failure (WHF) are serious complications in these patients.
• Optimal hydration strategies are critical for managing patients with advanced CHF undergoing coronary angiography (CAG).

Purpose of the Study:

• To investigate the association between weight-adjusted hydration volumes and the risk of CI-AKI and WHF.
• To explore the safety of optimal hydration volumes in advanced CHF patients undergoing CAG or percutaneous coronary intervention.
• To determine the impact of hydration volume-to-weight ratio (HV/W) on adverse outcomes.

Main Methods:

• A cohort of 551 patients with advanced CHF undergoing CAG was analyzed.
• Patients were stratified into quintiles based on hydration volume-to-weight ratio (HV/W).
• Statistical analysis, including trend analysis and receiver operating curve (ROC) analysis, was performed to assess the relationship between HV/W and outcomes.

Main Results:

• A significant trend was observed between increasing HV/W quintiles and higher incidences of CI-AKI and WHF (P-trend < 0.001).
• HV/W > 15 mL/kg was identified as an independent predictor for both CI-AKI (aOR 2.33) and WHF (aOR 2.13).
• Both CI-AKI and WHF were independently associated with increased long-term mortality.

Conclusions:

• HV/W > 15 mL/kg may be associated with an increased risk of CI-AKI and WHF in advanced CHF patients undergoing CAG.
• These complications are linked to higher long-term mortality.
• Personalized hydration volume limitation warrants further investigation in this high-risk population.