Prevention of Contrast-Induced Nephropathy by Central Venous Pressure–Guided Fluid Administration in Chronic Kidney Disease and Congestive Heart Failure Patients

Abstract

CVP-guided fluid administration can safely and effectively reduce the risk of CIN in patients with CKD and CHF. (Central Venous Pressure Guided Hydration Prevention for Contrast-Induced Nephropathy; NCT02405377).

2018 ESC/EACTS Guidelines on myocardial revascularization

“…Example: 370 mL of contrast medium in a patient with a GFR of 100 mL/min will yield a ratio of 3.7. d Options are: infusion of normal saline adjusted to central venous pressure 295 or furosemide with matched infusion of normal saline 296,297 12 Associated peripheral artery diseases…”

Contemporary practice patterns related to the risk of acute kidney injury in the catheterization laboratory: Results from a survey of Society of Cardiovascular Angiography and Intervention (SCAI) cardiologists

“…Infusion of sodium bicarbonate 0.84% instead of volume administration with normal saline in these latter guidelines is not indicated (Class III, LOE A). Emerging data would point to using hemodynamic guided expansion protocols based on either central venous or left ventricular filling pressures . The POSIDEIN trial examined the role of left ventricular end diastolic pressure (LVEDP) based protocol volume delivery .…”

Preventive Strategies for Contrast-Induced Acute Kidney Injury

“…However, several recent studies reinforced the concept of targeted hydration protocols — a single hydration protocol should not be applied to all patients. Several targeted hydration regimens have been proposed including left-ventricular end-diastolic pressure-guided hydration, 11 urine flow rate-guided hydration, 12 central venous pressure-guided hydration, 13 and bioimpedence guided-hydration. 14 In the POSEIDON trial, a strategy of left ventricular end-diastolic pressure (LVEDP)-guided volume expansion resulted in significant greater hydration than the standard fluid administration protocol (1727 mL versus 812 mL) resulting in a 59% reduction in the risk of CI-AKI (6.7% vs. 16.3%), suggesting that not all hydration protocols are created equal.…”