Preventing acute decrease in renal function induced by coronary angiography (PRECORD): a prospective randomized trial.
BACKGROUND
Infusion of saline attenuates the decrease in renal function induced by radiographic contrast agents among patients with chronic renal insufficiency.


OBJECTIVE
The Preventing Renal alteration in Coronary Disease (PRECORD) trial was a randomized trial to assess the effect on renal function of saline infusion during and after coronary angiography in 201 patients without severe chronic renal insufficiency (serum creatinine<140micromol/L).


METHODS
All patients received standard oral hydration: 2000mL of tap water within the 24 hours after coronary angiography. Patients were randomized before the procedure to intravenous hydration (1000mL of 0.9% saline infusion) or no additional hydration. The infusion was started in the catheterization laboratory and continued for 24 hours. The primary endpoint was the change in calculated creatinine clearance between baseline and 24 hours after coronary angiography. The same ionic low osmolar radiographic contrast agent (ioxaglate) was used in all patients.


RESULTS
Both groups had similar baseline characteristics, including age, serum creatinine, volume of contrast and proportion of patients undergoing ad hoc coronary angioplasty. The overall decrease in serum creatinine clearance 24 hours after the procedure was -3.44 (0.68)mL/min. The change in serum creatinine clearance 24 hours after the procedure was -2.81 (1.07)mL/min in the infusion group vs -4.09 (0.91)mL/min in the control group (p=0.38).


CONCLUSIONS
Renal function is altered only slightly 24 hours after coronary angiography with standard oral hydration alone and is not affected by saline infusion started at the beginning of coronary angiography, even in patients with mild-to-moderate renal dysfunction.
Angoulvant
Denis
D
Service de cardiologie D, hôpital cardiovasculaire et pneumologique Louis-Pradel, groupement hospitalier Est, université Claude-Bernard Lyon-1, avenue Doyen-Lepine, Bron cedex, France.
Cucherat
Michel
M
Rioufol
Gilles
G
Finet
Gérard
G
Beaune
Jacques
J
Revel
Didier
D
Laville
Maurice
M
Ovize
Michel
M
André-Fouët
Xavier
X
D000208:Acute Disease; D015415:Biomarkers / Q000097:blood; D003287:Contrast Media / Q000009:adverse effects*; D017023:Coronary Angiography / Q000009:adverse effects*; D003404:Creatinine / Q000097:blood; D005260:Female; D005440:Fluid Therapy; D006801:Humans; D007262:Infusions, Intravenous; D007485:Ioxaglic Acid / Q000009:adverse effects*; D007674:Kidney Diseases / Q000097:blood / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012965:Sodium Chloride / Q000008:administration & dosage*; D013997:Time Factors; D016896:Treatment Outcome
D015415:Biomarkers; D003287:Contrast Media; D012965:Sodium Chloride; D003404:Creatinine; D007485:Ioxaglic Acid