Background: Contrast-induced nephropathy has been the subject of many studies not only because of the morbidity associated with prolonged hospital stay, (with dialysis requirement in some cases), but also with an increase in mortality in these patients. The preventive strategy hydration with saline solution 0.9% NaCl is the choice. However, the infusion rate and total time of hydration remains controversial.
Methods and results: The study was performed in a single U.S. tertiary center, it randomized evaluated patients undergoing coronary angiography with an estimated creatinine clearance of <60ml/min, (by MDRD), and at least another risk factor for contrast nephropathy, (diabetes, age over 75 years, history of hypertension and heart failure). It excluded patients who had been exposed to contrast in the past 48 hours, carriers of severe valvular disease, congestive heart failure, primary angioplasty, and increased creatinine levels above 15% in the two days prior to the procedure.
Patients received 3ml/kg infusion of SF 0.9% one hour before the procedure. During the procedure they were selected according to two strategies to prevent acute injury iodinated contrast: one guided by the end-diastolic pressure of left ventricle evaluated (LVEDP) in the cath lab by placing a pigtail catheter in the left ventricle, (LVEDP ≤ 13mmHg was administered 5ml/kg/h, LVEDP 13-18mmHg, 3ml/kg/h, and LVEDP> 18, 1.5 ml / kg / h), and another consisting of the conventional infusion SF 0.9% (1.5 ml / kg / h). After the procedure, both groups received the same scheme infusion for 4 hours. There were no differences between the groups in terms of baseline characteristics.
The primary endpoint, (incidence of CIN), was 6.7% in the group led by LVEDP and 16.3% in the control group, (p = 0.005). Hydration volume was 1,711ml administered to the LVEDP group versus 807 for the control group, (p <0.001). There was no difference in clinical outcomes considered: Death (0% versus 1.5%, p = 0.25), stroke (0.5% versus 2%, p = 0.37) and the need for dialysis (0.5% vs. 1.5%, p = 0.62) in guided groups, LVEDP and control respectively. In patients who had a kidney injury by contrast in their evolution the probability of dialysis was 10% of cases and death in 5% of patients. The hydration had to be suspended in 1.5% of cases in each group.
Conclusions: LVEDP guided hydration resulted in a relative reduction of 59%, (10% absolute reduction), in the incidence of acute kidney injury induced by contrast media. This is a safe and effective strategy.
6_somjot_brar
Somjot Brar
2012-10-25
Original title: A Prospective, Randomized Trial of Sliding-Scale Hydration for Prevention of Contrast Nephropathy. POSEIDON study
