title: Effects of hydration in contrast-induced acute kidney injury after primary angioplasty: a randomized, controlled trial.
abstract: BACKGROUND
  Intravascular volume expansion represents a beneficial measure against contrast-induced acute kidney injury (CI-AKI) in patients undergoing elective angiographic procedures. However, the efficacy of this preventive strategy has not yet been established for patients with ST-elevation-myocardial infarction (STEMI), who are at higher risk of this complication after primary percutaneous coronary intervention (PCI). In this randomized study we investigated the possible beneficial role of periprocedural intravenous volume expansion and we compared the efficacy of 2 different hydration strategies in patients with STEMI undergoing primary PCI.
  
  
  RESULTS
  We randomly assigned 450 STEMI patients to receive (1) preprocedure and postprocedure hydration of sodium bicarbonate (early hydration group), (2) postprocedure hydration of isotonic saline (late hydration group), or (3) no hydration (control group). The primary end point was the development of CI-AKI, defined as an increase in serum creatinine of ≥25% or 0.5 mg/dL over the baseline value within 3 days after administration of the contrast medium. Moreover, we evaluated a possible relationship between the occurrence of CI-AKI and total hydration volume administered. There were no significant differences in baseline clinical, biochemical, and procedural characteristics in the 3 groups. Overall, CI-AKI occurred in 93 patients (20.6%): the incidence was significantly lower in the early hydration group (12%) with respect to both the late hydration group (22.7%) and the control group (27.3%) (P for trend=0.001). In hydrated patients (early and late hydration groups), lower infused volumes were associated with a significant increase in CI-AKI incidence, and the optimal cutoff point of hydration volume that best discriminates patients at higher risk was ≤960 mL.
  
  
  CONCLUSIONS
  Adequate intravenous volume expansion may prevent CI-AKI in patients undergoing primary PCI. A regimen of preprocedure and postprocedure hydration therapy with sodium bicarbonate appears to be more efficacious than postprocedure hydration only with isotonic saline.
authors.affiliation: Division of Cardiology, Misericordia e Dolce Hospital, Prato, Italy. mauro.maioli@fastwebnet.it
authors.forename: Mauro
authors.initials: M
authors.lastname: Maioli
authors.forename: Anna
authors.initials: A
authors.lastname: Toso
authors.forename: Mario
authors.initials: M
authors.lastname: Leoncini
authors.forename: Carlo
authors.initials: C
authors.lastname: Micheletti
authors.forename: Francesco
authors.initials: F
authors.lastname: Bellandi
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D000368:Aged; D017130:Angioplasty; D002985:Clinical Protocols; D003287:Contrast Media / Q000009:adverse effects*; D017023:Coronary Angiography / Q000009:adverse effects; D003404:Creatinine / Q000097:blood; D005260:Female; D005440:Fluid Therapy / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D019990:Perioperative Care; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D017693:Sodium Bicarbonate / Q000008:administration & dosage; D012965:Sodium Chloride / Q000008:administration & dosage
chemical_list: D003287:Contrast Media; D012965:Sodium Chloride; D017693:Sodium Bicarbonate; D003404:Creatinine