Higher hydration volume may not reduce the risk of contrast-induced nephropathy in patients with chronic kidney disease undergoing percutaneous coronary intervention

LIN Wen-xia; SHEN Tie-mei; LIU Yong; TAN Ning

摘要：Background Adequate hydration with isotonic saline is generally recommended to prevent contrast-induced nephropathy (CIN) in patients with chronic kidney disease (CKD). However, there is no well-defined protocol regarding the optimal rate and duration of normal saline administration. Methods Patients with CKD (estimated glomerular filtration rate [eGFR] ＜60 mL/min/1.73 m2) undergoing PCI with hydration at the speed recommended by the current guidelines (1 mL/kg/h [0.5 ml/kg/h for left ventricular ejection fraction ＜40％ or severe congestive heart failure]) were included in the study (n=631). CIN was defined as an increase in serum creatinine of ≥ 0.5 mg/dL or 25％ from the baseline within 48-72 hours after contrast exposure. Results Individuals with higher adequate hydration (HV/W ratios) were more likely to develop CIN (Q1, Q2, Q3, and Q4: 6.33％, 18.4％, 12.5％, and 21.52％, respectively; P=0.001), acute heart failure (5.7％, 6.13％, 9.21％, and 13.92％, respectively; P=0.035). Multivariate analyses showed that higher hydration volume was not significantly associated with a reduced risk of CIN (HV/W ratio Q2 vs. Q1: odds ratio [OR]: 2.36, 95％ confidence interval [CI]: 1.08～5.16; Q3 vs. Q1: OR: 1.47, 95％ CI: 0.63～3.4; Q4 vs. Q1: OR: 2.32, 95％ CI: 1.05～5.11). Conclusion Higher hydration volume may not reduce the risk of contrast-induced nephropathy in patients with CKD undergoing PCI.intravascular hydration volume at routine speed may not decrease the risk of CIN in patients with chronic kidney disease undergoing percutaneous coronary intervention.