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Left ventricular end-diastolic pressure-guided hydration for the prevention of contrast-induced acute kidney injury in patients with stable ischemic heart disease: the LAKESIDE trial.

Abstract：

OBJECTIVES:Contrast-induced acute kidney injury (CI-AKI) is a serious complication in patients undergoing diagnostic cardiac angiography or percutaneous coronary intervention. We aimed to evaluate the preventive effects of left ventricular end-diastolic pressure (LVEDP)-guided hydration for the prevention of CI-AKI in patients with chronic kidney disease undergoing cardiac catheterization. METHODS:This prospective randomized single-blind clinical trial enrolled 114 eligible patients with an estimated glomerular filtration rate (eGFR) of 15 < eGFR ≤ 60 mL/min/1.73 m2 [according to the level-modified Modification of Diet in Renal Disease formula (MDRD)] and stable ischemic heart disease undergoing coronary procedures. The patients were randomly allocated 1:1 into the LVEDP-guided hydration group (n = 57) or the standard hydration group (n = 57). CI-AKI was defined as a greater than 25% or greater than 0.5 mg/dL (44.2 mmol/L) increase in the serum creatinine concentration compared with the baseline value. Hydration with 0.9% sodium chloride at a rate of 1 mL/kg/h (0.5 mL/kg/h if left ventricular ejection fraction < 40%) within 12 h was given to all the patients in both groups before the procedure. In the LVEDP-guided group, the hydration infusion rate was adjusted according to the LVEDP level during and after the procedure. RESULTS:The incidence of CI-AKI was 7.01% (4/57) in the LVEDP-guided group vs 3.84% (2/52) in the standard hydration group (summary odds ratio 0.53, 95% CI 0.093-3.022; P = 0.463). Major adverse cardiac events, hemodialysis, or related deaths occurred in neither of the groups during hospitalization or the 30-day follow-up. CONCLUSIONS:In the present study, LVEDP-guided fluid administration, by comparison with standard hydration, failed to offer protection against the risk of CI-AKI in patients with renal insufficiency undergoing coronary angiography with or without percutaneous coronary intervention.

journal_name

Int Urol Nephrol

journal_title

International urology and nephrology

authors

Marashizadeh A,Sanati HR,Sadeghipour P,Peighambari MM,Moosavi J,Shafe O,Firouzi A,Zahedmehr A,Maadani M,Shakerian F,Kiani R,Mohebbi B,Alemzadeh-Ansari MJ,Tahvili R,Naghavi B

doi

10.1007/s11255-019-02235-w

subject

Has Abstract

pub_date

2019-10-01 00:00:00

pages

1815-1822

issue

eissn

0301-1623

issn

1573-2584

pii

10.1007/s11255-019-02235-w

journal_volume

pub_type

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Left ventricular end-diastolic pressure-guided hydration for the prevention of contrast-induced acute kidney injury in patients with stable ischemic heart disease: the LAKESIDE trial.