Association Of Adequate Hydration With Prevention Of Contrast-Induced Nephropathy In Patients With Cardiac Insufficiency

Background: The incidence of contrast-induced nephropathy(CIN)in patients undergoing PCI is about 2% to 25%.The incidence of CIN is often higher in patients with cardiac insufficiency due to the frequent hemodynamic compromise and the lack of sufficient time for adequate hydration.Some studies showed that compared with patients without CIN,CIN increased the risk of adverse cardiovascular events and mortality after PCI with even relatively stable hemodynamics after a 1-year follow-up.Recommended strategies to prevent CIN include adequate hydration,usage of low osemolar contrast media and a high-dose statin.Hydration speed should be halved(0.5ml/kg/h)if LVEF<35% or Killip class>I.Several studies have shown that adequate hydration may be associated with increased risk of CIN,and might bring about worsening heart failure(WHF).In addition,the efficacy of adequate hydration in preventing CIN and avoiding worsening heart failure was lacking in convinced evidence among patients with cardiac insufficiency(Killip>I or LVEF<40%).Therefore,it is necessary to explore the relationship between adequate hydration and the prevention of CIN in patients with cardiac insufficiency undergoing coronary intervention.1.The efficacy and safety of adequate hydration in the prevention of angiographic nephropathy in patients with acute myocardial infarction and cardiac insufficiency.Objective: The purpose of this study was to evaluate the relationship between adequate hydration and incidence of CIN and WHF among AMI patients with Killip class >I.Methods: In this prospective,observational registry study,407 acute myocardial infarction(AMI)patients with Killip class>I undergoing percutaneous coronary intervention(PCI)were analyzed.The recommended hydration rate is haved before or after the procedure(0.5 mL/kg/h for Killip class >I).The endpoint was CIN(an absolute increase in serum creatinine of ? 0.5 mg/dL or a relative increase of ? 25% within 48-72hours).Patients were divided into 2 groups by approximate median hydration volumn(HV)750ml.Multivariable logistic regression analysis was carried out to clarify the independent predictors of CIN and WHF.Results: The total incidence of CIN was 24.6% in this study.There was a significant association between hydration volume and CIN in two hydration groups(HV >750 mL vs.HV=<750mL: 28.46% vs.18.18%,P=0.020),the WHF(16.2% vs 5.19%,P=0.001).After adjusting for confounders,multivariate analysis showed that higher HV was significantly associated with CIN(adjusted odds ratio [OR]=1.829,95% confidence interval [CI](1.046,3.197),)and WHF risk(adjusted OR= 2.585,95% CI(1.104,6.055)),all P value<0.05.Conclusions: For AMI patients with Killip class>I,relatively adequate hydration(HV>750ml)may be associated with a higher risk of CIN and WHF.2.Association of adequate hydration with decreased risk of contrast-induced nephropathy in patients with reduced left ventricular ejection fractionObjectives: The objective of this study was to assess the association between adequate hydration and prevention of contrast-induced nephropathy(CIN)in patients with left ventricular ejection fraction(LVEF)<40%Methods: We analysed 282 patients with reduced LVEF undergoing coronary angiography(CAG)and percutaneous coronary intervention(PCI)at half the usual hydration rate(0.5 mL/kg/h).The hydration volume ratio(hydration volume/weight:HV/W)was calculated to identify the adequate hydration and insufficient hydration.The primary endpoint was the occurrence of CIN.Multivariate logistic regression were used to identify independent predictors of CIN and WHF.Results: The overall incidence of CIN was 18.79%.Patients with adequate hydration(HV/W >12 mL/kg)were more likely to develop CIN(26.67% vs.11.56%;P=0.001)and WHF(18.52% vs.2.72%,P<0.0001)compared with insufficient hydration(HV/W <=12 mL/kg).After adjusting for confounders,multivariate analysis showed that adequate hydration significantly increased the CIN risk(adjusted odds ratio[OR]=2.877,95% CI(1.082,7.653),P=0.034)and WHF risk(adjusted OR=11.177,95% CI(1.989,62.807),P=0.006).Conclusions: For patients with reduced LVEF,relatively adequate hydration volume may be associated with higher risk of CIN and may increase the risk of WHF.For patients with high risk of CIN and cardiac insufficiency,individualized hydration should be given in to avoid excessive hydration.