Acute kidney injury after primary angioplasty: effect of different hydration treatments.
OBJECTIVE
We evaluated the effect of different dose hydration protocols, with normal saline or bicarbonate, on the incidence of contrast-induced acute kidney injury (CI-AKI) in patients with ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PPCI).


METHODS
We considered 592 STEMI patients treated with PPCI in 5 Italian centers. Patients were randomized to receive standard or high-dose infusions of normal saline or sodium bicarbonate started immediately before contrast medium administration and continued for the following 12 h.


RESULTS
The cumulative incidence of CI-AKI was 18.1% without any difference among treatment groups. Shock, age, ejection fraction 35% or less, and basal serum creatinine were significantly associated with an increased risk of CI-AKI. Follow-up at 12 months was complete in 573 patients. Overall, 25 out of 573 patients died (4.3%). We observed higher short-term mortality rates in patients receiving high-volume hydration. Otherwise, only age, shock and CI-AKI were significantly associated with 1-year mortality.


CONCLUSIONS
In patients with STEMI undergoing PPCI, high-volume hydration with normal saline or sodium bicarbonate administrated at the time of contrast media administration was not associated with any significant advantage in terms of CI-AKI prevention.
aCardiologia Interventistica Azienda Ospedaliera-IRCCS S. Maria Nuova, Reggio Emilia bCardiologia, Nuovo Ospedale Civile S. Agostino-Estense, Modena cDipartimento di Cardiologia, Ospedali del Tigullio, Lavagna dDivisione di Cardiologia, Ospedale Maggiore, Parma eDivisione di Nefrologia, Dipartimento di Medicina Interna, Università di Parma fIBIS Informatica, Milan gIstituto di Cardiologia, Azienda Ospedaliera-Universitaria S. Anna, Ferrara, Italy.
Antonio
A
Manari
Paolo
P
Magnavacchi
Enrico
E
Puggioni
Luigi
L
Vignali
Enrico
E
Fiaccadori
Mila
M
Menozzi
Stefano
S
Tondi
Stefano
S
Robotti
Duilio
D
Ferrari
Marco
M
Valgimigli
D058186:Acute Kidney Injury / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D000368:Aged; D003287:Contrast Media / Q000009:adverse effects; D005260:Female; D005440:Fluid Therapy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D006801:Humans; D015994:Incidence; D007263:Infusions, Parenteral; D007558:Italy; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects* / Q000401:mortality; D012307:Risk Factors; D017693:Sodium Bicarbonate / Q000008:administration & dosage*; D012965:Sodium Chloride / Q000008:administration & dosage*; D013997:Time Factors; D016896:Treatment Outcome
D003287:Contrast Media; D012965:Sodium Chloride; D017693:Sodium Bicarbonate