Excessively High Hydration Volume May Not Be Associated With Decreased Risk of Contrast‐Induced Acute Kidney Injury After Percutaneous Coronary Intervention in Patients With Renal Insufficiency

Abstract

BackgroundNo well‐defined protocols currently exist regarding the optimal rate and duration of normal saline administration to prevent contrast‐induced acute kidney injury (CI‐AKI) in patients with renal insufficiency.Methods and ResultsHydration volume ratios (hydration volume/weight; HV/W) were calculated in 1406 patients with renal insufficiency (estimated glomerular filtration rate [eGFR], <90 mL/min per 1.73 m2) undergoing percutaneous coronary intervention (PCI) with routine speed hydration (1 or 0.5 mL/kg per hour). We investigated the relationship between hydration volume, risk of CI‐AKI (increase in serum creatinine ≥0.5 mg/dL or 25% within 48–72 hours), and prognosis. Mean follow‐up duration was 2.85±0.88 years. Individuals with higher HV/W were more likely to develop CI‐AKI (quartiles: Q1, Q2, Q3, and Q4: 4.3%, 6.6%, 10.9%, and 15.0%, respectively; P<0.001). After adjusting 12 confounders, including age, sex, eGFR, anemia, emergent PCI, diabetes mellitus, chronic heart failure, diuretics, contrast volume, lesions, smoking status, and number of stents, multivariate analysis showed that a higher HV/W ratio was not associated with a decreased CI‐AKI risk (Q2 vs Q1: adjusted odds ratio [OR], 1.13; Q3 vs Q1: adjusted OR, 1.51; Q4 vs Q1: adjusted OR, 1.87; all P>0.05) and even increased CI‐AKI risk (HV/W >25 mL/kg: adjusted OR, 2.11; 95% CI, 1.24–3.59; P=0.006). Additionally, higher HV/W was significantly associated with an increased risk of death (Q4 vs Q1: adjusted hazard ratio, 3.44; 95% CI, 1.20–9.88; P=0.022).ConclusionsExcessively high hydration volume at routine speed might be associated with increased risk of CI‐AKI and death post‐PCI in patients with renal insufficiency.

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

“…Moreover, several clinical trials have proven that a higher volume of hydration efficiently reduces the risk of CIN and other adverse events28293031. In contrast, Liu et al ., reported that excess hydration could not have a better effect on preventing CIN and may worsen heart failure17. The present study showed a higher hydration rate (77.4% vs. 45.7%) in high-risk patients with pre-existing renal disease than in patients with normal renal function, while the hydration volume was significantly lower.…”

“…According to a cross-sectional survey conducted in China, about 120 million adults have CKD (estimated glomerular filtration rate [eGFR]: <60 mL/min/1.73 m 2 )16 and approximately 60% of the patients undergoing PCI have CKD (eGFR <90 mL/min/1.73 m 2 )17. Therefore, hydration treatment is essential, especially in patients with risk factors such as kidney disease, reduced ventricular function and diabetes.…”

Acute kidney injury requiring dialysis and in‐hospital mortality in patients with chronic kidney disease and non–ST‐segment elevation acute coronary syndrome undergoing early vs delayed percutaneous coronary intervention: A nationwide analysis

“…They also found that IV hydration added to hospital cost and length of stay. A single‐center retrospective cohort study of patients undergoing PCI found that participants with a high ratio of hydration volume to weight actually had higher rates of CIN‐AKI and worse outcomes overall . Their findings challenge the established concept that IV hydration prevents CIN and suggest that it may even cause harm.…”

Intravenous Hydration and Contrast‐Induced Acute Kidney Injury: Too Much of a Good Thing?

“…In this issue of the Journal of the American Heart Association , Liu et al report their findings on hydration volume and incidence of CI‐AKI from a single‐center retrospective cohort study of participants undergoing PCI . They found that participants with a high ratio of hydration volume to weight (HV/W) actually had higher rates of CI‐AKI and worse outcomes overall.…”