Role of Hydration in Contrast-Induced Nephropathy in Patients Who Underwent Primary Percutaneous Coronary Intervention

Jurado-Román, Alfonso; Hernández-Hernández, Felipe; Garcı́a-Tejada, Julio; Granda-Nistal, Carolina; Molina, J. Ernesto; Velázquez, Maite; Albarrán, Agustín; Tascón, Juan

doi:10.1016/j.amjcard.2015.02.004

Cited by 103 publications

(91 citation statements)

References 17 publications

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“…These may further increase tubular cell injury. In addition, the beneficial effects of saline hydration in salvaging CIN due to catheterization techniques are well documented202122. The protective mechanisms underlying the salvaging effect have been investigated widely.…”

Section: Discussionmentioning

confidence: 99%

Post-Hoc Study: Intravenous Hydration Treatment in Chinese Patients with High Risk of Contrast-Induced Nephropathy Following Percutaneous Coronary Intervention

Bei

Lin

et al. 2017

Sci Rep

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Contrast-induced nephropathy (CIN) develops after the injection of iodinated contrast media. This is a post hoc analysis of the data obtained from the TRUST study, which was a prospective, multicentre, observational study conducted to evaluate the safety and tolerability of the contrast medium iopromide in patients undergoing cardiac catheterization from August 2010 to September 2011 in China, conducted to explore the current status, trends and risk predictors of hydration treatment. The status of hydration to prevent CIN in each patient was recorded. Of the total 17,139 patients from the TRUST study (mean age, 60.33 ± 10.38 years), the overall hydration usage was 46.1% in patients undergoing percutaneous coronary intervention (PCI) and 77.4%, 51.7%, and 48.5% in patients with pre-existing renal disease, diabetes mellitus, and hypertension, respectively. The proportion of hydration use increased from 36.5% to 55.5% from August 2010 to September 2011, which was independently associated with risk predictors like older age, pre-existing renal disease, hypertension, diabetes mellitus, prior myocardial infarction, ST segment elevation MI, high contrast dose, multi-vessel disease and reduced LVEF (<45%). Overall, the usage of intravenous hydration treatment for patients with a high risk of CIN following PCI was high in China.

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Section: Discussionmentioning

confidence: 99%

Post-Hoc Study: Intravenous Hydration Treatment in Chinese Patients with High Risk of Contrast-Induced Nephropathy Following Percutaneous Coronary Intervention

Bei

Lin

et al. 2017

Sci Rep

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“…On the other hand, this study excluded the patients with eGFR lower than 30 mL/min/1.73 m 2 , emergencies and intensive care patients with higher contrast volume or haemodynamic instability. Although the difference in risk of CIN between hydrated and non-hydrated groups is small within the subgroup analysis regarding interventional versus diagnostic procedure, these results cannot be generalised to include such patients with acute myocardial infarction where some benefit of hydration has been found (6,7). In addition, patients undergoing emergent percutaneous coronary intervention (PCI) are at high risk for CIN because of hemodynamic instability and infeasibility of adequate prophylaxis (8,9).…”

Section: Editorialmentioning

confidence: 83%

“…In addition, patients undergoing emergent percutaneous coronary intervention (PCI) are at high risk for CIN because of hemodynamic instability and infeasibility of adequate prophylaxis (8,9). There were only three clinical trials on the prevention of CIN including a randomly assigned group not receiving prophylaxis ( Table 1) (6,7,10). Two were done in patients with ST-elevation myocardial infarction, most of whom had normal renal function, and both found prophylaxis superior which might be explained by other factors such as higher contrast volume, haemodynamic instability and nephrotoxic treatments inherent to this population (6,7).…”

Section: Editorialmentioning

confidence: 99%

No prophylaxis is non-inferior and cost-saving to prophylactic intravenous hydration in preventing contrast-induced nephropathy on requiring iodinated contrast material administration

2017

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J Thorac Dis 2017;9(6):1440-1442 jtd.amegroups.com intravenous hydration as proposed by the guidelines to no prophylaxis in the high-risk population targeted by the guidelines. CIN incidences found in the AMACING trial were low (2.6-2.7%), and no haemodialysis or related deaths occurred within 35 days. The AMACING study found no prophylaxis to be non-inferior to prophylactic intravenous hydration in the prevention of CIN, as well as cost-saving. We often have worried about the development of CIN and subsequent haemodialysis in CKD patients on use of iodinated contrast material administration (5). Based on these results, withholding prophylaxis for high-risk patients with eGFR higher than 29 mL/min/1.73 m 2 might be considered without compromising patient safety. On the other hand, this study excluded the patients with eGFR lower than 30 mL/min/1.73 m 2 , emergencies and intensive care patients with higher contrast volume or haemodynamic instability. Although the difference in risk of CIN between hydrated and non-hydrated groups is small within the subgroup analysis regarding interventional versus diagnostic procedure, these results cannot be generalised to include such patients with acute myocardial infarction where some benefit of hydration has been found (6,7). In addition, patients undergoing emergent percutaneous coronary intervention (PCI) are at high risk for CIN because of hemodynamic instability and infeasibility of adequate prophylaxis (8,9). There were only three clinical trials on the prevention of CIN including a randomly assigned group not receiving prophylaxis (Table 1) (6,7,10). Two were done in patients with ST-elevation myocardial infarction, most of whom had normal renal function, and both found prophylaxis superior which might be explained by other factors such as higher contrast volume, haemodynamic instability and nephrotoxic treatments inherent to this population (6,7). James et al. performed a large meta-analysis and systematic review of mortality associated with CIN (11). They found that after adjustment for variables other than CIN that could contribute to the mortality, there was a significant reduction in the association between CIN and mortality. In the future, large clinical trials will provide further insight into the potential strengths of these results whether giving no prophylaxis is non-inferior to standard care prophylactic hydration on undergoing an elective procedure requiring iodinated contrast material administration. AcknowledgementsNone. Footnote Conflicts of Interest:The authors have no conflicts of interest to declare.

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“…Remedial hydration, as the name implies, means starting hydration during PPCI and maintaining it for 12-24 h after the procedure. Unfortunately, although remedial hydration had been used, the incidence of CIN after PPCI still reached 10-20% [7,13,15]. To date, the optimal hydration strategy has not been well established in AMI patients.…”

Section: Discussionmentioning

confidence: 99%

“…Adequate hydration during the perioperative period with 0.9% normal saline (NS) has been widely acknowledged as an effective way to prevent CIN [12,13,14]. However, morbidity remains high among high-risk groups, especially those suffering from AMI and undergoing PPCI.…”

Section: Introductionmentioning

confidence: 99%

Protective Effects of Salvianolate on Contrast-Induced Nephropathy after Primary Percutaneous Coronary Intervention: A Prospective Multicenter Randomized Controlled Trial

Huang

Yuan²,

Ma³

et al. 2017

Cardiology

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Objectives: This study's aim was to evaluate the protective effects of salvianolate on contrast-induced nephropathy after primary percutaneous coronary intervention (PPCI) compared with normal saline (NS) hydration. Methods: We enrolled patients with acute myocardial infarction who underwent PPCI in 3 centers in Shanghai. The patients were randomly assigned to the salvianolate group or the NS group. The incidence of CIN, the changes in renal function parameters, and the occurrence of adverse events after the procedure were compared between the 2 groups. We used a multivariate logistic regression analysis to determine the independent correlates of CIN after PPCI. Results: A total of 484 patients were finally included in the statistical analysis. Compared with the control group, salvianolate reduced the incidence of CIN (9.1 vs. 16.3%, p = 0.018) after PPCI. The renal function parameters after PPCI in the salvianolate group were superior to those of the control group (p < 0.05). The composite adverse events rate was significantly lower in the salvianolate group within 1 month after the procedure (9.5 vs. 15.5%, p = 0.046). A higher peak of troponin I and loop diuretic therapy were the independent correlates of CIN after PPCI. Conclusions: Salvianolate reduces the incidence of CIN and protects renal function after PPCI, and the effects were superior to those of NS hydration.

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Role of Hydration in Contrast-Induced Nephropathy in Patients Who Underwent Primary Percutaneous Coronary Intervention

Cited by 103 publications

References 17 publications

Post-Hoc Study: Intravenous Hydration Treatment in Chinese Patients with High Risk of Contrast-Induced Nephropathy Following Percutaneous Coronary Intervention

Post-Hoc Study: Intravenous Hydration Treatment in Chinese Patients with High Risk of Contrast-Induced Nephropathy Following Percutaneous Coronary Intervention

No prophylaxis is non-inferior and cost-saving to prophylactic intravenous hydration in preventing contrast-induced nephropathy on requiring iodinated contrast material administration

Protective Effects of Salvianolate on Contrast-Induced Nephropathy after Primary Percutaneous Coronary Intervention: A Prospective Multicenter Randomized Controlled Trial

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