Open AccessExcessively 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
Author(s) -
Liu Yong,
Li Hualong,
Chen Shiqun,
Chen Jiyan,
Tan Ning,
Zhou Yingling,
Liu Yuanhui,
Ye Piao,
Ran Peng,
Duan Chongyang,
Chen Pingyan
Publication year - 2016
Publication title -
journal of the american heart association
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.494
H-Index - 85
ISSN - 2047-9980
DOI - 10.1161/jaha.115.003171
Subject(s) - medicine , percutaneous coronary intervention , acute kidney injury , cardiology , percutaneous , kidney , myocardial infarction
Background No 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 Results Hydration 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 m 2 ) 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). Conclusions Excessively high hydration volume at routine speed might be associated with increased risk of CI ‐ AKI and death post‐ PCI in patients with renal insufficiency.