Hydration for prevention of kidney injury after primary coronary intervention for acute myocardial infarction: a randomised clinical trial

Yong Liu, Ning Tan, Yong Huo, Shiqun Chen, Jin Liu, Yun Dai Chen, Keng Wu, Guifu Wu, Kaihong Chen, Jianfeng Ye, Yan Liang, Xinwu Feng, Shaohong Dong, Qiming Wu, Xianhua Ye, Hesong Zeng, Minzhou Zhang, Min Dai, Chong Yang Duan, Guoli SunYibo He, Feier Song, Zhaodong Guo, Ping Yan Chen, Junbo Ge, Ying Xian, Jiyan Chen

Research output: Contribution to journalArticlepeer-review

Abstract

OBJECTIVE: To evaluate the efficacy of aggressive hydration compared with general hydration for contrast-induced acute kidney injury (CI-AKI) prevention among patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI). METHODS: The Aggressive hydraTion in patients with STEMI undergoing pPCI to prevenT Contrast-Induced Acute Kidney Injury study is an open-label, randomised controlled study at 15 teaching hospitals in China. A total of 560 adult patients were randomly assigned (1:1) to receive aggressive hydration or general hydration treatment. Aggressive hydration group received preprocedural loading dose of 125/250 mL normal saline within 30 min, followed by postprocedural hydration performed for 4 hours under left ventricular end-diastolic pressure guidance and additional hydration until 24 hours after pPCI. General hydration group received ≤500 mL 0.9% saline at 1 mL/kg/hour for 6 hours after randomisation. The primary end point is CI-AKI, defined as a >25% or 0.5 mg/dL increased in serum creatinine from baseline during the first 48-72 hours after primary angioplasty. The safety end point is acute heart failure. RESULTS: From July 2014 to May 2018, 469 patients were enrolled in the final analysis. CI-AKI occurred less frequently in aggressive hydration group than in general hydration group (21.8% vs 31.1%; risk ratio (RR) 0.70, 95% CI 0.52 to 0.96). Acute heart failure did not significantly differ between the aggressive hydration group and the general hydration group (8.1% vs 6.4%, RR 1.13, 95% CI 0.66 to 2.44). Several subgroup analysis showed the better effect of aggressive hydration in CI-AKI prevention in male, renal insufficient and non-anterior myocardial infarction participants. CONCLUSIONS: Comparing with general hydration, the peri-operative aggressive hydration seems to be safe and effective in preventing CI-AKI among patients with STEMI undergoing pPCI.

Original languageEnglish (US)
Pages (from-to)948-955
Number of pages8
JournalHeart (British Cardiac Society)
Volume108
Issue number12
DOIs
StatePublished - May 25 2022
Externally publishedYes

Keywords

  • coronary angiography
  • myocardial infarction
  • percutaneous coronary intervention

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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