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Simplified Rapid Hydration Prevents Contrast-Associated Acute Kidney Injury Among CKD Patients Undergoing Coronary

Yong Liu1, Ning Tan1, Yong Huo2

  • 1Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China; Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.

JACC. Cardiovascular Interventions
|June 28, 2023
PubMed

Insights

Simplified rapid hydration is as effective as standard hydration for preventing contrast-associated acute kidney injury (CA-AKI) in chronic kidney disease (CKD) patients undergoing coronary angiography (CAG). This approach significantly reduces hydration duration, offering a more convenient option for CA-AKI prevention.

Area of Science:

  • Nephrology
  • Cardiology
  • Radiology

Background:

  • Patients with chronic kidney disease (CKD) undergoing coronary angiography (CAG) face a high risk of contrast-associated acute kidney injury (CA-AKI) and mortality.
  • There is a critical clinical need for safe, convenient, and effective strategies to prevent CA-AKI in this vulnerable population.

Purpose of the Study:

  • To evaluate if a simplified rapid hydration protocol is noninferior to standard hydration in preventing CA-AKI.
  • To compare the efficacy and safety of simplified hydration versus standard hydration in CKD patients undergoing CAG.

Main Methods:

  • A multicenter, open-label, randomized controlled study involving 1,002 CKD patients.
  • Patients were assigned to either simplified hydration (SH) (3 mL/kg/h saline from 1 hour before to 4 hours after CAG) or standard hydration (1 mL/kg/h saline for 12 hours before and after CAG).
  • CA-AKI was defined as a ≥25% or 0.5-mg/dL rise in serum creatinine within 48–72 hours post-procedure.

Main Results:

  • CA-AKI occurred in 6.2% of patients in the SH group versus 8.4% in the standard hydration group (P = 0.216), demonstrating noninferiority.
  • No significant differences were observed in the risk of acute heart failure or 1-year major adverse cardiovascular events between the groups.
  • The median hydration duration was substantially shorter in the SH group (6 hours) compared to the standard group (25 hours; P < 0.001).

Conclusions:

  • Simplified rapid hydration is a noninferior strategy to standard hydration for preventing CA-AKI in CKD patients undergoing CAG.
  • The SH protocol offers a significant reduction in hydration duration, enhancing patient convenience.
  • This simplified approach provides a safe and effective alternative for CA-AKI prevention in high-risk patients.
Abstract

Keywords:
acute heart failurechronic kidney diseasecontrast-associated acute kidney injurycoronary angiographyintravenous hydration

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