Aggressive hydration averts contrast-induced AKI in STEMI patients undergoing PCI

Perioperative aggressive hydration appears to be better than general hydration at preventing contrast-induced acute kidney injury (AKI) among patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI), a study has found.

The study randomized 560 adult patients with STEMI who were scheduled to undergo PCI to receive aggressive hydration or general hydration treatment. Aggressive hydration involved administering a preprocedural loading dose of 125/250 mL normal saline within 30 min, followed by postprocedural hydration that lasted for 4 hours under left ventricular end-diastolic pressure guidance, then additional hydration until 24 hours after PCI. For general hydration, ≤500 mL 0.9% saline solution was administered at 1 mL/kg/hour for 6 hours following randomization.

Of the randomized patients, 469 were included in the final analysis. The primary endpoint of contrast-induced AKI, which was defined as an increase of >25 percent or 0.5 mg/dL in serum creatinine from baseline during the first 48–72 hours after primary angioplasty, occurred with significantly lower frequency in the aggressive vs general hydration group (21.8 percent vs 31.1 percent; risk ratio [RR], 0.70, 95 percent confidence interval [CI], 0.52–0.96).

In terms of safety, there was no significant difference seen in acute heart failure between the aggressive hydration group and the general hydration group (8.1 percent vs 6.4 percent, respectively; RR, 1.13, 95 percent CI, 0.66–2.44). Further analysis showed that aggressive hydration was more effective at preventing contrast-induced AKI in subgroups of male patients, those with renal insufficiency, and those with nonanterior myocardial infarction.