Intravenous volume expansion to prevent contrast-associated acute kidney injury.

Autor:	Briguori C; Interventional Cardiology Unit, Mediterranea Cardiocentro, Naples. Email: carlobriguori@clinicamediterranea.it., Di Iorio A; Interventional Cardiology Unit, Mediterranea Cardiocentro, Naples., Riviezzo G; Interventional Cardiology Unit, Mediterranea Cardiocentro, Naples., Scafuri S; Interventional Cardiology Unit, Mediterranea Cardiocentro, Naples., Focaccio A; Interventional Cardiology Unit, Mediterranea Cardiocentro, Naples., Paolucci L; Interventional Cardiology Unit, Mediterranea Cardiocentro, Naples., Cavaliere V; Interventional Cardiology Unit, Mediterranea Cardiocentro, Naples., Di Micco F; Interventional Cardiology Unit, Mediterranea Cardiocentro, Naples., Mariano E; Interventional Cardiology Unit, University of Rome Tor Vergata, Rome, Italy., Celotto R; Interventional Cardiology Unit, University of Rome Tor Vergata, Rome, Italy., Valenti F; Interventional Cardiology Unit, University of Rome Tor Vergata, Rome, Italy., Sangiorgi GM; Interventional Cardiology Unit, University of Rome Tor Vergata, Rome, Italy., Biondi-Zoccai G; Interventional Cardiology Unit, Mediterranea Cardiocentro, Naples; Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy.
Jazyk:	angličtina
Zdroj:	The Journal of invasive cardiology [J Invasive Cardiol] 2023 Nov; Vol. 35 (11).
DOI:	10.25270/jic/23.00187
Abstrakt:	Objectives: Several volume expansion protocols have been proposed to prevent contrast-associated acute kidney injury (CA-AKI). The aim of our study was to seek the ideal intravenous volume expansion to prevent CA-AKI in patients with chronic kidney disease (CKD) undergoing invasive cardiovascular procedures. Methods: We analyzed 1927 CKD patients enrolled in 6 studies that took place from September 15, 2000 to June 6, 2019. Four volume expansion regiments were included: (1) conventional group (n=625); (2) bicarbonate group (n=255); (3) left ventricular end-diastolic pressure-guided group (n=355); and (4) urine flow rate-guided group (n=500). Results: CA-AKI (serum creatinine increase ≥0.3 mg/dL at 48 hours) occurred in 224 (11%) patients. In patients with CA-AKI, volume expansion was lower (2090 ± 1382 mL vs 2551 ± 1716 mL; P less than .001) and acute pulmonary edema occurred more often (3.5% vs 0.29%; P less than .001). By ROC curve analysis, an absolute volume expansion greater than or equal to 1430 mL (AUC = 0.70) and a volume expansion to contrast media volume ratio greater than or equal to 17 (AUC = 0.57) were the best thresholds for freedom from CA-AKI. Conclusions: In our comprehensive pooled analysis, an absolute volume expansion greater than or equal to 1430 mL and a volume expansion to contrast media volume ratio greater than or equal to 17 are the best dichotomous thresholds for CA-AKI prevention. These cutoffs should be formally tested in a dedicated trial as a pragmatic means to prevent CA-AKI.
Databáze:	MEDLINE
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