Simplified Rapid Hydration in Preventing Contrast-Associated Acute Kidney Injury

Jun 27, 2023
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Authors:
Liu Y, Tan N, Huo Y, et al.
Citation:
Simplified Rapid Hydration Prevents Contrast-Associated Acute Kidney Injury Among CKD Patients Undergoing Coronary Angiography. JACC Cardiovasc Interv 2023;16:1503-1513.
Summary By:
Debabrata Mukherjee, MD, FACC

Quick Takes

  • Simplified hydration (SH) protocol was noninferior to the standard hydration protocol in preventing contrast-associated acute kidney injury (CA-AKI) in chronic kidney disease patients undergoing coronary angiography.
  • Furthermore, SH did not increase the risk of acute heart failure in these patients.
  • Given some limitations of the current study, additional prospective studies are indicated to validate these findings and evaluate the effect of SH on CA-AKI prevention in patients undergoing contrast studies.

Study Questions:

Is simplified rapid hydration noninferior to standard hydration for contrast-associated acute kidney injury (CA-AKI) prevention in patients with chronic kidney disease (CKD)?

Methods:

The investigators conducted a multicenter, open-label, randomized, controlled study across 21 teaching hospitals and included 1,002 patients with CKD. Patients were randomized to either simplified hydration (SH) (SH group, with normal saline from 1 hour before to 4 hours after coronary angiography at a rate of 3 mL/kg/h) or standard hydration (control group, with normal saline 12 hours before and 12 hours after coronary angiography at a rate of 1 mL/kg)/h). The primary endpoint of CA-AKI was ≥25% or 0.5 mg/dL rise in serum creatinine from baseline within 48-72 hours. Univariate log-binomial regression was used to evaluate the intervention effect in primary and secondary endpoints, and the risk ratio (RR) and absolute risk difference (ARD) are reported with 95% confidence intervals (CIs).

Results:

CA-AKI occurred in 29 of 466 (6.2%) patients in the SH group and in 38 of 455 (8.4%) patients in the control group (relative risk, 0.8; 95% CI, 0.5-1.2; p = 0.216). In addition, the risk of acute heart failure and 1-year major adverse cardiovascular events did not differ significantly between the groups. However, the median hydration duration was significantly shorter in the SH group than in the control group (6 hours vs. 25 hours, p < 0.001).

Conclusions:

The authors report that in CKD patients undergoing coronary angiography, simplified hydration is noninferior to standard hydration in preventing CA-AKI, with a shorter hydration duration.

Perspective:

This open-label study showed that the simple hydration protocol was noninferior to the standard hydration protocol in preventing CA-AKI in CKD patients undergoing coronary angiography. Furthermore, SH did not increase the risk of acute heart failure in these patients. Of note, SH greatly shortened hydration duration compared with standard long-term hydration and appears safe and convenient in patients with CKD. Given some limitations of the current study, additional prospective studies are indicated to validate these findings and evaluate the effect of SH on CA-AKI prevention in patients undergoing contrast studies.

Clinical Topics: Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Prevention, Acute Heart Failure, Interventions and Imaging, Angiography, Nuclear Imaging

Keywords: Acute Kidney Injury, Contrast Media, Coronary Angiography, Creatinine, Diagnostic Imaging, Heart Failure, Renal Insufficiency, Chronic, Risk, Secondary Prevention


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