Hydration for prevention of kidney injury after primary coronary intervention for acute myocardial infarction: a randomised clinical trial

Yong Liu; Ning Tan; Yong Huo; Shiqun Chen; Jin Liu; Yun-Dai Chen; Keng Wu; Guifu Wu; Kaihong Chen; Jianfeng Ye; Yan Liang; Xinwu Feng; Shaohong Dong; Qiming Wu; Xianhua Ye; Hesong Zeng; Minzhou Zhang; Min Dai; Chong-Yang Duan; Guoli Sun; Yibo He; Feier Song; Zhaodong Guo; Ping-Yan Chen; Junbo Ge; Ying Xian; Jiyan Chen

doi:10.1136/heartjnl-2021-319716

Hydration for prevention of kidney injury after primary coronary intervention for acute myocardial infarction: a randomised clinical trial

Heart. 2022 May 25;108(12):948-955. doi: 10.1136/heartjnl-2021-319716.

Authors

Yong Liu^#^{1

2}, Ning Tan^#^{1

2}, Yong Huo^#³, Shiqun Chen^{1

2}, Jin Liu^{1

2}, Yun-Dai Chen⁴, Keng Wu⁵, Guifu Wu⁶, Kaihong Chen⁷, Jianfeng Ye⁸, Yan Liang⁹, Xinwu Feng¹⁰, Shaohong Dong¹¹, Qiming Wu¹², Xianhua Ye¹³, Hesong Zeng¹⁴, Minzhou Zhang¹⁵, Min Dai¹⁶, Chong-Yang Duan¹⁷, Guoli Sun^{1

2}, Yibo He^{1

2}, Feier Song^{1

2}, Zhaodong Guo^{1

2}, Ping-Yan Chen¹⁶, Junbo Ge¹⁸, Ying Xian¹⁹, Jiyan Chen^{20

2}

Affiliations

¹ Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China.
² Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China.
³ Cardiology, Peking University First Hospital, Beijing, China.
⁴ Cardiology, The First Medical Center, Chinese PLA General Hospital, Beijing, China.
⁵ Cardiology, The Affiliated Hospital, Guangdong Medical University, Zhanjiang, Guangdong, China.
⁶ Cardiology, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong, China.
⁷ Cardiology, Longyan First Affiliated Hospital, Fujian Medical University, Longyan, Fujian, China.
⁸ Cardiology, Dongguan People's Hospital, Dongguan, Guangdong, China.
⁹ Cardiology, Maoming People's Hospital, Maoming, Guangdong, China.
¹⁰ Cardiology, The First People's Hospital of Zhaoqing, Zhaoqing, Guangdong, China.
¹¹ Cardiology, Shenzhen People's Hospital, Shenzhen, Guangdong, China.
¹² Cardiology, Beijing Ditan Hospital, Capital Medical University, Beijing, China.
¹³ Cardiology, Hangzhou First People's Hospital, Hangzhou, Zhejiang, China.
¹⁴ Cardiology, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, China.
¹⁵ Cardiology, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China.
¹⁶ Cardiology, Mianyang Central Hospital, Changjia Alley 12, Fucheng District, Mianyang, Sichuan, China.
¹⁷ Biostatistics, The State Key Laboratory of Organ Failure Research, The Key Laboratory of Tropical Disease Research, School of Public HealthMedical University, Guangzhou, Guangdong, China.
¹⁸ Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China.
¹⁹ Neurology, Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA.
²⁰ Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China chenjiyandr@126.com.

^# Contributed equally.

PMID: 34509996
DOI: 10.1136/heartjnl-2021-319716

Abstract

Objective: To evaluate the efficacy of aggressive hydration compared with general hydration for contrast-induced acute kidney injury (CI-AKI) prevention among patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI).

Methods: The Aggressive hydraTion in patients with STEMI undergoing pPCI to prevenT Contrast-Induced Acute Kidney Injury study is an open-label, randomised controlled study at 15 teaching hospitals in China. A total of 560 adult patients were randomly assigned (1:1) to receive aggressive hydration or general hydration treatment. Aggressive hydration group received preprocedural loading dose of 125/250 mL normal saline within 30 min, followed by postprocedural hydration performed for 4 hours under left ventricular end-diastolic pressure guidance and additional hydration until 24 hours after pPCI. General hydration group received ≤500 mL 0.9% saline at 1 mL/kg/hour for 6 hours after randomisation. The primary end point is CI-AKI, defined as a >25% or 0.5 mg/dL increased in serum creatinine from baseline during the first 48-72 hours after primary angioplasty. The safety end point is acute heart failure.

Results: From July 2014 to May 2018, 469 patients were enrolled in the final analysis. CI-AKI occurred less frequently in aggressive hydration group than in general hydration group (21.8% vs 31.1%; risk ratio (RR) 0.70, 95% CI 0.52 to 0.96). Acute heart failure did not significantly differ between the aggressive hydration group and the general hydration group (8.1% vs 6.4%, RR 1.13, 95% CI 0.66 to 2.44). Several subgroup analysis showed the better effect of aggressive hydration in CI-AKI prevention in male, renal insufficient and non-anterior myocardial infarction participants.

Conclusions: Comparing with general hydration, the peri-operative aggressive hydration seems to be safe and effective in preventing CI-AKI among patients with STEMI undergoing pPCI.

Keywords: coronary angiography; myocardial infarction; percutaneous coronary intervention.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Acute Kidney Injury* / chemically induced
Acute Kidney Injury* / prevention & control
Contrast Media / adverse effects
Heart Failure* / etiology
Humans
Kidney
Male
Myocardial Infarction* / therapy
Percutaneous Coronary Intervention* / adverse effects
Risk Factors
ST Elevation Myocardial Infarction* / etiology
ST Elevation Myocardial Infarction* / therapy
Treatment Outcome

Substances

Contrast Media