POSEIDON Trial: Novel Sliding Scale Hydration Effective for the Prevention of CI-AKI

Left ventricular end-diastolic pressure (LVEDP) guided hydration was associated with a 59 percent reduction in the rate of contrast-induced acute kidney injury (CI-AKI), according to results of the Prevention of Contrast Renal Injury with Different Hydration Strategies (POSEIDON) trial presented on Oct. 25 at TCT 2012 in Miami, Fl.

The POSEIDON trial aimed to investigate a novel sliding scale hydration protocol based upon LVEDP. The primary outcome, CI-AKI, was defined as a >25 percent or >0.5 mg/dl increase in serum creatinine up to four days post-procedure. Results showed the primary endpoint was observed in 6.7 percent of the LVEDP based hydration strategy group and in 16.3 percent of the standard hydration group (P = 0.005). The relative risk (95 percent CI) for LVEDP based hydration vs. standard hydration was 0.41 (0.22-0.79) and the absolute risk difference was -9.5 percent in favor of LVEDP based hydration (P = 0.005).

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During the study patients undergoing coronary angiography or percutaneous coronary intervention (PCI) with stable renal insufficiency (an estimated Glomerular Filtration Rate (GFR) <60 ml/min./1.73 m2) were randomized 1:1 to a LVEDP guided hydration strategy or a standard hydration strategy. For at least an hour before receiving cardiac catheterization, both groups were given 0.9 percent saline at 3 ml/kg. The LVEDP was measured in all patients at the start of the procedure and prior to contrast administration. In the LVEDP group, the fluid rate was adjusted according to the LVEDP (5 ml/kg/hr for LVEDP <13 mmHg; 3 ml/kg/hr for 13-18 mmHg; 1.5 ml/kg/hr for >18 mmHg), while the standard hydration group was hydrated at 1.5 ml/kg/hr. The fluid rate was set at the start of the procedure (prior to contrast exposure) and continued up until four hours after the procedure.

The investigators conclude that the study showed that LVEDP guided hydration strategy for prevention of contrast nephropathy resulted in a significant relative and absolute reduction in contrast nephropathy. Further, they note that it is an easily implemented protocol that can be readily adopted in the outpatient and inpatient settings.

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