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Role of Hydration in Contrast-Induced Nephropathy in Patients Who Underwent Primary Percutaneous Coronary
Zhuoqun Wang1, Yunping Song1, Geru A1
1Department of Cardiology, Tianjin Medical University General Hospital.
Insights
Intravenous saline hydration significantly reduces contrast-induced nephropathy (CIN) risk in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PPCI). This simple measure improves kidney outcomes without increasing mortality or need for dialysis.
Area of Science:
- Cardiology
- Nephrology
- Interventional Cardiology
Background:
- Patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI) face a higher risk of contrast-induced nephropathy (CIN) compared to elective PCI.
- Preventive measures for CIN are less commonly implemented in PPCI settings.
- Current guidelines lack specific recommendations for CIN prevention in STEMI patients undergoing PPCI.
Purpose of the Study:
- To evaluate the efficacy of periprocedural hydration with isotonic saline in preventing contrast-induced nephropathy (CIN) in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI).
Main Methods:
- A meta-analysis was conducted, including three randomized trials with a total of 924 patients.
- Patients were divided into two groups: one receiving periprocedural hydration with isotonic saline and a control group receiving no hydration.
- Data were collected through formal searches of electronic databases (PubMed, EMBASE, Cochrane) and internet-based clinical trial sources from 1966 to July 2018.
Main Results:
- Periprocedural hydration with isotonic saline was associated with a significant reduction in CIN rates (16.9% in the hydration group vs. 26.4% in the control group).
- The summary risk ratio for CIN was 0.64 (95% CI: 0.50-0.82, P = 0.0005).
- No significant differences were observed in the rates of postprocedural hemodialysis or death between the hydration and control groups.
Conclusions:
- Intravenous saline hydration during PPCI is an effective strategy for reducing the risk of CIN in STEMI patients.
- This hydration strategy does not significantly increase the requirement for renal replacement therapy or mortality.
- Implementing periprocedural hydration with isotonic saline is a recommended preventive measure for CIN in this high-risk patient population.
Abstract:
Patients with ST-segment elevation myocardial infarction (STEMI) who are treated by primary percutaneous coronary intervention (PPCI) have an increased risk of developing contrast-induced nephropathy (CIN) when compared with patients undergoing elective percutaneous coronary intervention (PCI). However, CIN prevention measures are less frequently applied in PPCI than in elective PCI. At present, no preventive strategy has been recommended by the current guidelines for patients with STEMI undergoing PPCI.Published research was scanned by formal searches of electronic databases (PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials) from 1966 to July 2018. Internet-based sources of information on the results of clinical trials in cardiology were also searched.A total of three randomized trials involving 924 patients were included in the present meta-analysis, of whom 462 received hydration with isotonic saline (hydration group) and 462 received no hydration (control group). Periprocedural hydration with isotonic saline was associated with a significant decrease in the rate of CIN (16.9% in the hydration group versus 26.4% in the control group; summary risk ratio: 0.64, 95% confidence interval: 0.50-0.82, P = 0.0005). There was no difference in the rate of postprocedural hemodialysis or death between the groups.Intravenous saline hydration during PPCI reduced the risk of CIN without significantly altering the rate of requirement for renal replacement therapy or mortality.
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