Hydration for prevention of kidney injury after primary coronary intervention for acute myocardial infarction: a randomised clinical trial
- 11 September 2021
- Vol. 108 (12), 948-955
- https://doi.org/10.1136/heartjnl-2021-319716
Abstract
Objective To evaluate the efficacy of aggressive hydration compared with general hydration for contrast-induced acute kidney injury (CI-AKI) prevention among patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI). Methods The Aggressive hydraTion in patients with STEMI undergoing pPCI to prevenT Contrast-Induced Acute Kidney Injury study is an open-label, randomised controlled study at 15 teaching hospitals in China. A total of 560 adult patients were randomly assigned (1:1) to receive aggressive hydration or general hydration treatment. Aggressive hydration group received preprocedural loading dose of 125/250 mL normal saline within 30 min, followed by postprocedural hydration performed for 4 hours under left ventricular end-diastolic pressure guidance and additional hydration until 24 hours after pPCI. General hydration group received ≤500 mL 0.9% saline at 1 mL/kg/hour for 6 hours after randomisation. The primary end point is CI-AKI, defined as a >25% or 0.5 mg/dL increased in serum creatinine from baseline during the first 48–72 hours after primary angioplasty. The safety end point is acute heart failure. Results From July 2014 to May 2018, 469 patients were enrolled in the final analysis. CI-AKI occurred less frequently in aggressive hydration group than in general hydration group (21.8% vs 31.1%; risk ratio (RR) 0.70, 95% CI 0.52 to 0.96). Acute heart failure did not significantly differ between the aggressive hydration group and the general hydration group (8.1% vs 6.4%, RR 1.13, 95% CI 0.66 to 2.44). Several subgroup analysis showed the better effect of aggressive hydration in CI-AKI prevention in male, renal insufficient and non-anterior myocardial infarction participants. Conclusions Comparing with general hydration, the peri-operative aggressive hydration seems to be safe and effective in preventing CI-AKI among patients with STEMI undergoing pPCI.Keywords
Funding Information
- National Science Foundation of China (81500520, 81670339)
- Beijing Lisheng Cardiovascular Health Foundation and the Guangdong Provincial People's Hospital (2014dzx02, LHJJ20141751)
- Guangdong Provincial Clinical Research Center for Cardiovascular disease (2020B1111170011)
- Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention (2017B030314041)
This publication has 31 references indexed in Scilit:
- Use of the contrast volume or grams of iodine–to–creatinine clearance ratio to predict mortality after percutaneous coronary interventionAmerican Heart Journal, 2013
- 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial InfarctionJournal of Invasive Cardiology, 2012
- Persistent Renal Damage After Contrast-Induced Acute Kidney InjuryJournal of the American College of Cardiology, 2012
- Prevention of Contrast Nephropathy by Furosemide With Matched HydrationJACC: Cardiovascular Interventions, 2012
- Effects of Hydration in Contrast-Induced Acute Kidney Injury After Primary AngioplastyCirculation: Cardiovascular Interventions, 2011
- Impact of High-Dose N-Acetylcysteine Versus Placebo on Contrast-Induced Nephropathy and Myocardial Reperfusion Injury in Unselected Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention: The LIPSIA-N-ACC (Prospective, Single-Blind, Placebo-Controlled, Randomized Leipzig Immediate PercutaneouS Coronary Intervention Acute Myocardial Infarction N-ACC) TrialJournal of Invasive Cardiology, 2010
- Cystatin C and Contrast-Induced Acute Kidney InjuryJournal of the American College of Cardiology, 2010
- The Reno-Protective Effect of Hydration With Sodium Bicarbonate Plus N-Acetylcysteine in Patients Undergoing Emergency Percutaneous Coronary Intervention: The RENO StudyJournal of Invasive Cardiology, 2007
- N-Acetylcysteine and Contrast-Induced Nephropathy in Primary AngioplastyThe New England Journal of Medicine, 2006
- Analysis of multiple failure time data from an AIDS clinical trial by Dianne M. Finkelstein, David A. Schoenfeld and Eva Stamenovic, Statistics in Medicine, 16, 951-961 (1997)Statistics in Medicine, 1998