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

Authors
  • Liu, Yong1, 2
  • Tan, Ning1, 2
  • Huo, Yong3
  • Chen, Shiqun1, 2
  • Liu, Jin1, 2
  • Chen, Yun-Dai4
  • Wu, Keng5
  • Wu, Guifu6
  • Chen, Kaihong7
  • Ye, Jianfeng8
  • Liang, Yan9
  • Feng, Xinwu10
  • Dong, Shaohong11
  • Wu, Qiming12
  • Ye, Xianhua13
  • Zeng, Hesong14
  • Zhang, Minzhou15
  • Dai, Min16
  • Duan, Chong-Yang17
  • Sun, Guoli1, 2
  • And 7 more
  • 1 Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China. , (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. , (China)
  • 3 Cardiology, Peking University First Hospital, Beijing, China. , (China)
  • 4 Cardiology, The First Medical Center, Chinese PLA General Hospital, Beijing, China. , (China)
  • 5 Cardiology, The Affiliated Hospital, Guangdong Medical University, Zhanjiang, Guangdong, China. , (China)
  • 6 Cardiology, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong, China. , (China)
  • 7 Cardiology, Longyan First Affiliated Hospital, Fujian Medical University, Longyan, Fujian, China. , (China)
  • 8 Cardiology, Dongguan People's Hospital, Dongguan, Guangdong, China. , (China)
  • 9 Cardiology, Maoming People's Hospital, Maoming, Guangdong, China. , (China)
  • 10 Cardiology, The First People's Hospital of Zhaoqing, Zhaoqing, Guangdong, China. , (China)
  • 11 Cardiology, Shenzhen People's Hospital, Shenzhen, Guangdong, China. , (China)
  • 12 Cardiology, Beijing Ditan Hospital, Capital Medical University, Beijing, China. , (China)
  • 13 Cardiology, Hangzhou First People's Hospital, Hangzhou, Zhejiang, China. , (China)
  • 14 Cardiology, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, China. , (China)
  • 15 Cardiology, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China. , (China)
  • 16 Cardiology, Mianyang Central Hospital, Changjia Alley 12, Fucheng District, Mianyang, Sichuan, China. , (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. , (China)
  • 18 Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China. , (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 [email protected] , (China)
Type
Published Article
Journal
Heart
Publisher
BMJ
Publication Date
May 25, 2022
Volume
108
Issue
12
Pages
948–955
Identifiers
DOI: 10.1136/heartjnl-2021-319716
PMID: 34509996
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

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). 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. 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. 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. © Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.

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