Higher hydration volume may not reduce the risk of contrast-induced nephropathy in patients with chronic kidney disease undergoing percutaneous coronary intervention

摘要

Background Adequate hydration with isotonic saline is generally recommended to prevent contrast-induced nephropathy(CIN) in patients with chronic kidney disease(CKD). However, there is no well-defined protocol regarding the optimal rate and duration of normal saline administration. Methods Patients with CKD(estimated glomerular filtration rate [e GFR] <60 m L/min/1.73 m2) undergoing PCI with hydration at the speed recommended by the current guidelines(1 m L/kg/h [0.5 ml/kg/h for left ventricular ejection fraction <40% or severe congestive heart failure]) were included in the study(n=631). CIN was defined as an increase in serum creatinine of ≥0.5 mg/d L or 25% from the baseline within 48-72 hours after contrast exposure. Results Individuals with higher adequate hydration(HV/W ratios) were more likely to develop CIN(Q1, Q2, Q3, and Q4: 6.33%, 18.4%,12.5%, and 21.52%, respectively; P=0.001), acute heart failure(5.7%, 6.13%, 9.21%, and 13.92%, respectively;P=0.035). Multivariate analyses showed that higher hydration volume was not significantly associated with a reduced risk of CIN(HV/W ratio Q2 vs. Q1: odds ratio [OR]: 2.36, 95% confidence interval [CI]: 1.08~5.16; Q3 vs. Q1: OR: 1.47, 95% CI: 0.63~3.4; Q4 vs. Q1: OR: 2.32, 95% CI: 1.05~5.11). Conclusion Higher hydration volume may not reduce the risk of contrast-induced nephropathy in patients with CKD undergoing PCI.intravascular hydration volume at routine speed may not decrease the risk of CIN in patients with chronic kidney disease undergoing percutaneous coronary intervention.