Acute kidney injury after primary angioplasty

Abstract

In patients with STEMI undergoing PPCI, high-volume hydration with normal saline or sodium bicarbonate administrated at the time of contrast media administration was not associated with any significant advantage in terms of CI-AKI prevention.

Association between prophylactic hydration volume and risk of contrast-induced nephropathy after emergent percutaneous coronary intervention

“…Findings of a recent study have also shown that a higher saline HV (1085 ± 168 mL vs. 941 ± 148 mL) did not reduce the rate of CI-AKI (19% vs. 19.2%) following primary angioplasty, even with rapid hydration before the procedure [8]. These findings are similar to those from the present study in which similar patients underwent emergent procedures.…”

“…Furthermore, a higher hydration volume (HV) has been associated with a significant trend towards a lower incidence of CIN [7]. However, no benefit existed in patients who were undergoing primary PCI and were administered more aggressive hydration [8].…”

“…Therefore, no well-defined protocols have been established regarding the optimal total HV and hydration duration for CIN prevention following emergent PCI. Since the hydration rate has been based on body weight (W) (1 mL/kg/h) in previous studies [6][7][8][9], we investigated the associations between the HV adjusted according to W (HV/W, mL/kg) and the risk of CIN after emergent PCI.…”

Bicarbonato de sodio versus solución salina isotónica para la prevención de la nefropatía inducida por medio de contraste: Revisión sistemática y meta-análisis

“…Among the studies that included SB administration, 18 administered SB diluted with 5% dextrose in distilled water (D5%DW), and 4 did not specify the dilution of bicarbonate used 16 - 19 ; however, stabilized bicarbonate is only achieved with the addition of dextrose, so it can be assumed that this dilution was performed. The quantity of D5%DW for dilution differed among the studies; in 16 studies, 154 mL of bicarbonate (1,000 mEq/L) was diluted in 846 mL of D5%DW (studies 8 , 15 , 20 - 32 , 33 ); in the remaining studies, different mixtures of bicarbonate and D5%DW were used; the infusion speed was 1 to 3 mL/k/h within 1 to 12 h before the radiological procedure was performed and then between 6 and 12 h post-procedure ( Table 1 ). In six studies 20 , 21 , 23 , 27 , 29 , 32 , NAC was used along with the sodium bicarbonate.…”

“…The primary outcome evaluated in 13 studies was the presence of CIN, defined as a 25% elevation in serum creatinine above the baseline or a 0.5-mg/dL increase during the first 48 hours after the contrast medium was administered 8 , 15 , 16 , 17 , 19 - 22 , 27 , 29 - 32 ; in seven studies, the same definition was used, but CIN was diagnosed up to 5 days post-contrast medium administration 23 , 25 , 26 , 28 , 33 - 35 ; the other two studies used the maximum increase in serum creatinine as an outcome measure 18 , 24 .…”