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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.

journal of the american heart association

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