Geng Qian1, Zhenhong Fu2, Jun Guo2, Feng Cao2, Yundai Chen3. 1. Department of Cardiology, Chinese People's Liberation Army General Hospital, Peking, China. Electronic address: qiangeng9396@263.net. 2. Department of Cardiology, Chinese People's Liberation Army General Hospital, Peking, China. 3. Department of Cardiology, Chinese People's Liberation Army General Hospital, Peking, China. Electronic address: cyundai@vip.163.com.
Abstract
OBJECTIVES: This study aimed to explore the hemodynamic index-guided hydration method for patients with congestive heart failure (CHF) and chronic kidney disease (CKD) to reduce the risk of contrast-induced nephropathy (CIN) and at the same time to avoid the acute heart failure. BACKGROUND:Patients at moderate or high risk for CIN should receive sufficient hydration before contrast application. METHODS: This prospective, randomized, double-blind, comparative clinical trial enrolled 264 consecutive patients with CKD and CHF undergoing coronary procedures. These patients were randomly assigned to either central venous pressure (CVP)-guided hydration group (n = 132) or the standard hydration group (n = 132). In the CVP-guided group, the hydration infusion rate was dynamically adjusted according to CVP level every hour. CIN was defined as an absolute increase in serum creatinine (SCr) >0.5 mg/dl (44.2 μmol/l) or a relative increase >25% compared with baseline SCr. RESULTS: Baseline characteristics were well-matched between the 2 groups. The total mean volume of isotonic saline administered in the CVP-guided hydration group was significantly higher than the control group (1,827 ± 497 ml vs. 1,202 ± 247 ml; p < 0.001). CIN occurred less frequently in CVP-guided hydration group than the control group (15.9% vs. 29.5%; p = 0.006). The incidences of acute heart failure during the hydration did not differ between the 2 groups (3.8% vs. 3.0%; p = 0.500). CONCLUSIONS: CVP-guided fluid administration can safely and effectively reduce the risk of CIN in patients with CKD and CHF. (Central Venous Pressure Guided Hydration Prevention for Contrast-Induced Nephropathy; NCT02405377).
RCT Entities:
OBJECTIVES: This study aimed to explore the hemodynamic index-guided hydration method for patients with congestive heart failure (CHF) and chronic kidney disease (CKD) to reduce the risk of contrast-induced nephropathy (CIN) and at the same time to avoid the acute heart failure. BACKGROUND:Patients at moderate or high risk for CIN should receive sufficient hydration before contrast application. METHODS: This prospective, randomized, double-blind, comparative clinical trial enrolled 264 consecutive patients with CKD and CHF undergoing coronary procedures. These patients were randomly assigned to either central venous pressure (CVP)-guided hydration group (n = 132) or the standard hydration group (n = 132). In the CVP-guided group, the hydration infusion rate was dynamically adjusted according to CVP level every hour. CIN was defined as an absolute increase in serum creatinine (SCr) >0.5 mg/dl (44.2 μmol/l) or a relative increase >25% compared with baseline SCr. RESULTS: Baseline characteristics were well-matched between the 2 groups. The total mean volume of isotonic saline administered in the CVP-guided hydration group was significantly higher than the control group (1,827 ± 497 ml vs. 1,202 ± 247 ml; p < 0.001). CIN occurred less frequently in CVP-guided hydration group than the control group (15.9% vs. 29.5%; p = 0.006). The incidences of acute heart failure during the hydration did not differ between the 2 groups (3.8% vs. 3.0%; p = 0.500). CONCLUSIONS: CVP-guided fluid administration can safely and effectively reduce the risk of CIN in patients with CKD and CHF. (Central Venous Pressure Guided Hydration Prevention for Contrast-Induced Nephropathy; NCT02405377).
Authors: David M Safley; Adam C Salisbury; Thomas T Tsai; Eric A Secemsky; Kevin F Kennedy; R Kevin Rogers; Faisal Latif; Nicolas W Shammas; Lawrence Garcia; Matthew A Cavender; Kenneth Rosenfield; Anand Prasad; John A Spertus Journal: JACC Cardiovasc Interv Date: 2021-02-08 Impact factor: 11.195
Authors: Matthew T James; Bryan J Har; Benjamin D Tyrrell; Peter D Faris; Zhi Tan; John A Spertus; Stephen B Wilton; William A Ghali; Merril L Knudtson; Tolulope T Sajobi; Neesh I Pannu; Scott W Klarenbach; Michelle M Graham Journal: JAMA Date: 2022-09-06 Impact factor: 157.335