Avoiding the emergence of contrast-induced acute kidney injury in acute coronary syndrome: routine hydration treatment

Abstract

Background: Patients with acute coronary syndrome (ACS) have about a three-fold risk for developing contrast-induced acute kidney injury(CI-AKI). Investigating studies on routine hydration therapy have frequently included patients with stable coronary artery disease and high risk of CI-AKI [estimated glomerular filtration rate (eGFR) < 60 ml/min]. However, data on routine hydration treatment in non-ST segment elevation myocardial infarction (NSTEMI) patients with eGFR ≥60 ml/min are insufficient. We aimed to investigate the association between routine hydration therapy and CI-AKI development in NSTEMI patients at low risk for nephropathy. Methods and results: We randomly assigned a total of 401 NSTEMI patients to two groups: the routine hydration group (198 patients) and the nonhydration group (control group) (203 patients). Intravenous hydration with isotonic saline (1 ml/kg/h, 0.9% sodium chloride) was given for 3–12 h before and 24 h after contrast exposure to the hydration group. CI-AKI was defined as the increase in serum creatinine values 0.5 mg/dl or 25% between 48 and 72 h after the invasive procedures. In our study, the incidence of CI-AKI development in the routine hydration group (7.1%) was significantly lower than in the nonhydration group (14.1%) (P: 0.02). This study revealed that older age, amount of contrast media, and routine hydration were independent risk factors for developing CI-AKI (P < 0.01, P: 0.04, P < 0.01, respectively). Conclusion: We found that preprocedural and postprocedural intravenous hydration therapy reduces the development of CI-AKI in patients with NSTEMI at low risk for CI-AKI. We suggest administering routine hydration therapy in all ACS patients regardless of eGFR values.

Challenges and Burdens in the Coronary Artery Disease Care Pathway for Patients Undergoing Percutaneous Coronary Intervention: A Contemporary Narrative Review

“…Furthermore, contrast media administration during angiography and PCI can increase the risk of contrast-induced acute kidney injury, an impairment of renal function reported in up to 10% of cardiac catheterization and PCI patients [145,147]. Patients with ACS have about a three-fold risk of developing contrast-induced acute kidney injury versus those without ACS [148]. This impairment is associated with short-and long-term mortality and MACE [149,150].…”

A study of the clinical impact of different heart rate control management in patients with STEMI after percutaneous coronary intervention

“…Acute ST-segment elevation myocardial infarction (SETMI) is an important form of coronary atherosclerosis and is the primary cause of death in people with coronary heart disease. The emergency percutaneous coronary intervention has been developing in recent years, and breakthroughs have been made for the treatment of acute SETMI, which has largely reduced its disability and fatality rates [5][6] Percutaneous coronary intervention is one of the effective methods of clinical treatment of myocardial infarction at present, but there is also the risk of coronary artery restenosis and ischemia after the operation. At present, after carrying out PCI, clinicians usually ask post-PCI patients to rest in bed for two days before they can start their activities as a way to better help the post-PCI patients recover their health [11][12].…”

Contrast-Associated Acute Kidney Injury: Advances and Challenges

“…38 , 39 In recent studies, hydration therapy has also been shown to reduce the incidence of CA-AKI in patients with eGFR≥60 mL/min/1.73 m 2 . 40 However, excessive transfusion may increase the risk of heart failure, arrhythmia and short-term death in high-risk patients. 41 Therefore, the implementation of hydration therapy should be guided according to the central venous pressure (CVP), left ventricular end diastolic pressure (LVEDP), bioimpedance and urine volume.…”