Effect Of Combining Furosemide With Standard Hydration Therapy On Contrast-induced Acute Kidney Injury Following Coronary Angiography Or Intervention In A High-risk Population

Part I.Effect of combining furosemide with standard hydration therapy on contrast-induced acute kidney injury following coronary angiography or intervention in a high-risk populationObjective:This study aimed to investigate whether combining furosemide with standard hydration therapy results in increased preventive effects on contrast-induced acute kidney injury(CI-AKI)following coronary angiography(CA)or percutaneous coronary intervention(PCI).Methods:230 Patients were enrolled in the study and were randomized to the furosemide group or the control group who were scheduled to undergo CA or PCI.Eligible consecutive patients without exclusion criteria.Patients in the furosemide group received furosemide combined with a standard hydration regimen:0.2–0.5 mg/kg furosemide as a continuous intravenous infusion for 24 h after the procedure,and the same standard hydration regimen as the control group.Patients in the control group received a standard hydration regimen:1.0-1.5 m L/kg/h of normal saline as a continuous intravenous infusion for 12 h before and 24 h postoperatively.Patients with heart failure requiring fluid restriction received 3 m L/kg/h of normal saline for 1 h before the procedure and 1 m L/kg/h of normal saline for 6 h after the procedure.Blood samples were obtained 24 h before the procedure and 48 h after the procedure,to measure serum creatinine(SCr)and electrolytes.Urine volume was recorded at 6,12and 24 h postoperatively.Results:(1)The incidence of CI-AKI in the furosemide group was significantly lower than that in the control group(8.7 vs 18.3%,P=0.034).The post-procedure SCr level in the furosemide group was significantly lower than that in the control group(91.3±30.6 vs 98.0±38.0μmol/L,P=0.049).Postoperative urine volume at 24 h in the furosemide group was non-significantly higher than that in the control group(1,745.5±297.1 vs 1,741.6±311.7 m L,P=0.697).There were no significant differences in postoperative estimated glomerular filtration rate(e GFR)between the two groups(74.6±25.6 vs 70.2±26.9 ml/min/1.73 m~2,P=0.981).(2)Univariate logistic regression showed that PCI treatment,furosemide intervention,e GFR,age-glomerular filtration rate-ejection fraction score(AGEF),and contrast volume/e GFR ratio(V/e GFR)were related to CI-AKI incidence.The furosemide therapy reduced the risk of CI-AKI(odds ratio(OR)0.426,95%confidence interval(CI)0.191-0.951,P=0.037).Conclusion:Furosemide combined with standard hydration therapy may reduce the incidence of CI-AKI.PCI treatment,low e GFR,high AGEF score and V/e GFR ratio were risk factors of CI-AKI.Part II.Analysis on early predictors of contrast-induced acute kidney injury after coronary angiography or intervention in a high-risk populationObjective: This study aimed to analyze the early predictors and its clinical value of CIAKI in high-risk patients after coronary angiography or intervention.Methods: 230 Patients were enrolled in the study with high risk of CI-AKI who were scheduled to undergo CA or PCI.Blood samples were obtained 24 h before the procedure and 48 h after the procedure,to measure SCr.Patients were assigned to the CI-AKI group and the non-CI-AKI group according to the diagnostic criteria of CIAKI.The clinical features of the two groups were analyzed.All of these factors were included into multivariate Logistic regression analysis to determine the independent correlates of CI-AKI after coronary angiography or intervention.Predictive values for the independent risk factors of CI-AKI were assessed using receiver operating characteristic(ROC)curves.Results:(1)Multivariate logistic regression showed that AGEF score and V/e GFR ratio were independent risk factors for CI-AKI.Multivariate logistic regression showed that AGEF score(OR 6.837,95% CI(2.026-23.072),P=0.002)and V/e GFR ratio(OR 3.190,95% CI(1.383-7.360),P=0.007)were independent risk factors for CI-AKI,with higher AGEF score and V/e GFR ratio indicating higher risk.(2)ROC curves suggested predictive values of AGEF score and V/e GFR ratio: the AGEF threshold value was 2.11(sensitivity 74.2%,specificity 70.4%,area under the curve(AUC)0.761,95% CI(0.674-0.849),P<0.001)and the V/e GFR threshold value was 2.09(sensitivity 77.4%,specificity 72.4%,AUC 0.794,95% CI(0.720-0.868),P<0.001).Conclusion: AGEF score and V/eGFR ratio were independent risk factors for CI-AKI in high-risk patients after coronary angiography or intervention,in which AGEF score >2.11 or V/e GFR ratio >2.09 were early predictors for CI-AKI.Part III.The impact of combining furosemide with standard hydration therapy on long-term prognosis in high-risk patients following coronary angiography or interventionObjective: This study aimed to observe the impact of combining furosemide with standard hydration therapy on long-term prognosis in patients following coronary angiography or intervention on the basis of reducing the incidence of CI-AKI.Methods: 230 Patients were enrolled in the study and were randomized to the furosemide group or the control group who were scheduled to undergo CA or PCI.Eligible consecutive patients without exclusion criteria.Patients in the furosemide group received furosemide combined with a standard hydration regimen: 0.2–0.5 mg/kg furosemide as a continuous intravenous infusion for 24 h after the procedure,and the same standard hydration regimen as the control group.Patients in the control group received a standard hydration regimen: 1.0-1.5 m L/kg/h of normal saline as a continuous intravenous infusion for 12 h before and 24 h postoperatively.Patients with heart failure requiring fluid restriction received 3 m L/kg/h of normal saline for 1 h before the procedure and 1 m L/kg/h of normal saline for 6 h after the procedure.Patients were followed up for an average of 6 months after the procedure.The occurrence of major adverse cardiac events(MACEs),rehospitalization rate,dialysis,mortality,ischemic stroke events within 6 months after procedure were respectively observed and compared between the two groups.MACEs free survival rate was analyzed using Kaplan-Meier survival curves.Results:(1)Follow-up duration was an average of 6 months.The rehospitalization rate in the furosemide group was significantly lower than that in the control group(14.0 vs 25.7%,P=0.028).The incidence of major adverse cardiovascular events(MACEs)in the furosemide group was significantly lower than that in the control group(3.5 vs 13.3%,P=0.008).(2)Kaplan-Meier survival curves of freedom from MACEs in both groups showed that the risk of MACEs in the furosemide group was significantly lower than that in the control group(96.5% vs 86.9%,P=0.008).Conclusion: Furosemide treatment along with hydration therapy reduced the postoperative rehospitalization rate and the incidence of MACEs,which can be used as a safe individualized treatment regimen and can significantly improve important clinical outcomes in high-risk patients undergoing coronary angiography or intervention.