BACKGROUND: Intravascular volume expansion represents a beneficial measure against contrast-induced acute kidney injury (CI-AKI) in patients undergoing elective angiographic procedures. However, the efficacy of this preventive strategy has not yet been established for patients with ST-elevation-myocardial infarction (STEMI), who are at higher risk of this complication after primary percutaneous coronary intervention (PCI). In this randomized study we investigated the possible beneficial role of periprocedural intravenous volume expansion and we compared the efficacy of 2 different hydration strategies in patients with STEMI undergoing primary PCI. METHODS AND RESULTS: We randomly assigned 450 STEMI patients to receive (1) preprocedure and postprocedure hydration of sodium bicarbonate (early hydration group), (2) postprocedure hydration of isotonic saline (late hydration group), or (3) no hydration (control group). The primary end point was the development of CI-AKI, defined as an increase in serum creatinine of ≥25% or 0.5 mg/dL over the baseline value within 3 days after administration of the contrast medium. Moreover, we evaluated a possible relationship between the occurrence of CI-AKI and total hydration volume administered. There were no significant differences in baseline clinical, biochemical, and procedural characteristics in the 3 groups. Overall, CI-AKI occurred in 93 patients (20.6%): the incidence was significantly lower in the early hydration group (12%) with respect to both the late hydration group (22.7%) and the control group (27.3%) (P for trend=0.001). In hydrated patients (early and late hydration groups), lower infused volumes were associated with a significant increase in CI-AKI incidence, and the optimal cutoff point of hydration volume that best discriminates patients at higher risk was ≤960 mL. CONCLUSIONS: Adequate intravenous volume expansion may prevent CI-AKI in patients undergoing primary PCI. A regimen of preprocedure and postprocedure hydration therapy with sodium bicarbonate appears to be more efficacious than postprocedure hydration only with isotonic saline.
RCT Entities:
BACKGROUND: Intravascular volume expansion represents a beneficial measure against contrast-induced acute kidney injury (CI-AKI) in patients undergoing elective angiographic procedures. However, the efficacy of this preventive strategy has not yet been established for patients with ST-elevation-myocardial infarction (STEMI), who are at higher risk of this complication after primary percutaneous coronary intervention (PCI). In this randomized study we investigated the possible beneficial role of periprocedural intravenous volume expansion and we compared the efficacy of 2 different hydration strategies in patients with STEMI undergoing primary PCI. METHODS AND RESULTS: We randomly assigned 450 STEMI patients to receive (1) preprocedure and postprocedure hydration of sodium bicarbonate (early hydration group), (2) postprocedure hydration of isotonic saline (late hydration group), or (3) no hydration (control group). The primary end point was the development of CI-AKI, defined as an increase in serum creatinine of ≥25% or 0.5 mg/dL over the baseline value within 3 days after administration of the contrast medium. Moreover, we evaluated a possible relationship between the occurrence of CI-AKI and total hydration volume administered. There were no significant differences in baseline clinical, biochemical, and procedural characteristics in the 3 groups. Overall, CI-AKI occurred in 93 patients (20.6%): the incidence was significantly lower in the early hydration group (12%) with respect to both the late hydration group (22.7%) and the control group (27.3%) (P for trend=0.001). In hydrated patients (early and late hydration groups), lower infused volumes were associated with a significant increase in CI-AKI incidence, and the optimal cutoff point of hydration volume that best discriminates patients at higher risk was ≤960 mL. CONCLUSIONS: Adequate intravenous volume expansion may prevent CI-AKI in patients undergoing primary PCI. A regimen of preprocedure and postprocedure hydration therapy with sodium bicarbonate appears to be more efficacious than postprocedure hydration only with isotonic saline.
Authors: Jeremiah R Brown; Daniel M Pearlman; Emily J Marshall; Shama S Alam; Todd A MacKenzie; Alejandro Recio-Mayoral; Vitor O Gomes; Bokyung Kim; Lisette O Jensen; Christian Mueller; Mauro Maioli; Richard J Solomon Journal: Am J Cardiol Date: 2016-08-24 Impact factor: 2.778
Authors: José Mariani; Cristiano Guedes; Paulo Soares; Silvio Zalc; Carlos M Campos; Augusto C Lopes; André G Spadaro; Marco A Perin; Antonio Esteves Filho; Celso K Takimura; Expedito Ribeiro; Roberto Kalil-Filho; Elazer R Edelman; Patrick W Serruys; Pedro A Lemos Journal: JACC Cardiovasc Interv Date: 2014-10-15 Impact factor: 11.195
Authors: Steven D Weisbord; Martin Gallagher; James Kaufman; Alan Cass; Chirag R Parikh; Glenn M Chertow; Kendrick A Shunk; Peter A McCullough; Michael J Fine; Maria K Mor; Robert A Lew; Grant D Huang; Todd A Conner; Mary T Brophy; Joanne Lee; Susan Soliva; Paul M Palevsky Journal: Clin J Am Soc Nephrol Date: 2013-05-09 Impact factor: 8.237
Authors: Jeremiah R Brown; Richard J Solomon; Mark J Sarnak; Peter A McCullough; Mark E Splaine; Louise Davies; Cathy S Ross; Harold L Dauerman; Janette L Stender; Sheila M Conley; John F Robb; Kristine Chaisson; Richard Boss; Peggy Lambert; David J Goldberg; Deborah Lucier; Frank A Fedele; Mirle A Kellett; Susan Horton; William J Phillips; Cynthia Downs; Alan Wiseman; Todd A MacKenzie; David J Malenka Journal: Circ Cardiovasc Qual Outcomes Date: 2014-07-29