Ya-Chen Zhang, Abstract Co-Author: Research Grant, General Electric Company

Yong Tang, Abstract Co-Author: Research Grant, General Electric Company

Jian Chen, Abstract Co-Author: Research Grant, General Electric Company

Qing Zhou, Abstract Co-Author: Research Grant, General Electric Company

Yu-Quan Xie, Abstract Co-Author: Research Grant, General Electric Company

Man-Tian Chen, Abstract Co-Author: Research Grant, General Electric Company

Shu Meng, Abstract Co-Author: Research Grant, General Electric Company

Cheng-Xing Shen, Abstract Co-Author: Research Grant, General Electric Company

Yi-Gang Li, Abstract Co-Author: Research Grant, General Electric Company

Xiaozheng Yang, Presenter: Research Grant, General Electric Company

Though hydration is one of widely accepted methods to decrease the incidence of contrast-induced acute kidney injury (CI-AKI), the regimens and concentration for hydration was still debatable. The study was going to compare the effectiveness of 3 kinds of hydration regimens used routinely in clinical for prevention of CI-AKI in patients with renal insufficiency undergoing percutaneous coronary intervention or angiography (PCI).

300 patients with serum creatinine (SCr) > 97 μmol/L undergoing PCI were randomized into 3 different groups equally. 0.45% (w/w) sodium chloride was given to group 1 at a rate of 1ml/kg/h 12h before and after procedure. Group 2 received 0.9% (w/w) sodium chloride with the same administration strategy. Group 3 was treated with 1.25% (w/w) sodium bicarbonate 1h before procedure (3ml/kg/h), 6h after procedure (1ml/kg/h). Iodixanol 320 mgI/ml (Visipaque, GE Healthcare) was given during all procedure with a volume of 95 - 190 ml. The primary endpoint was incidence of CI-AKI defined as a relative increase in Scr of ≧ 25% from baseline in 72 hours after administration of contrast. Secondary endpoints were the incidence of major adverse cardiac and cerebral events (including allcause death, myocardial infarction (MI), re-PCI, and stroke) in 6 months after procedure.

All subjects finished the study and were eligible for analysis. The average Scr peaked in 48 hour in all groups. Group 1 had a significantly highest peaked level of SCr (116.9 ± 20.5) than other two groups (P < 0.05), while there was no significant difference between group 2 and group 3 (110.6 ± 12.5 vs 113.4 ± 12.1). The incidence of CI-AKI in group 1, group 2 and group 3 were 12%, 4%, 3%, respectively (all P < 0.05). Patients developed CI-AKI after procedure had greater risk of MI than patients without CI-AKI (Log-rank test, P < 0.01).

When PCI needs to be done on patients with renal insufficiency, using 1.25% sodium bicarbonate solution for hydration can not only reduce the risk of developing CI-AKI, but also improve the longterm prognosis.

This study provided vital clinical proofs on hydration application for PCI. Patients benefit most from hydration with 1.25% sodium bicarbonate. With a shorter time of pre-procedure, this regimen is also practicable in emergent PCI.

Zhang, Y, Tang, Y, Chen, J, Zhou, Q, Xie, Y, Chen, M, Meng, S, Shen, C, Li, Y, Yang, X, Different Hydration Regimens for Prevention of Contrast-induced Nephropathy in Patients with Renal Insufficiency Undergoing Coronary Angiography or Intervention.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14010193.html