Introduction:
Adequate hydration with isotonic saline is generally recommended to prevent contrast-induced nephropathy (CIN) in patients with chronic kidney disease (CKD). However, no well-defined protocols regarding the optimal rate and duration of normal saline administration currently exist.
Hypothesis:
Higher intravascular hydration volume of normal saline adjusted by weight (hydration volume/weight [HV/W], mL/kg) can reduce the risk of CIN in patients with CKD undergoing percutaneous coronary intervention (PCI).
Methods:
Patients with CKD (creatinine clearance [CrCl] <90 mL/min/1.73 m2) undergoing PCI with hydration at the speed recommended by the current guidelines (1 mL/kg/h [0.5 mL/kg/h for left ventricular ejection fraction <40% or severe congestive heart failure]) were included in the study (n=1406).
Results:
Individuals with higher HV/W ratios were more likely to develop CIN (Q1, Q2, Q3, and Q4: 4.3%, 6.6%, 10.9%, and 15.0%, respectively; P<0.001) and acute heart failure (0.29%, 2.28%, 2.73%, and 5.01%, respectively; P=0.001), and were associated with higher in-hospital costs (8,314, 8,634, 9,274, 10,073 dollars, respectively; P25 mL/kg), the adjusted OR was 1.93 (95% CI: 1.09~3.42; P=0.025). Additionally, higher hydration was significantly associated with an increased risk of death (Q2 vs. Q1: adjusted hazard ratio [HR]: 3.59, 95% CI: 1.19~10.84; Q3 vs. Q1: adjusted HR: 3.51, Q4 vs. Q1: adjusted HR: 4.29, P<0.05).
Conclusions:
Excessive intravascular hydration volume at routine speed was associated with higher risks of CIN, acute heart failure, and death, as well as increased health care costs.
Contrast induced nephropathy with ultra-low contrast percutaneous coronary intervention under intravascular ultrasound guidance in patients of chronic kidney disease
