title: Prevention of Contrast-Induced Nephropathy by Central Venous Pressure-Guided Fluid Administration in Chronic Kidney Disease and Congestive Heart Failure Patients.
abstract: OBJECTIVE
  This study aimed to explore the hemodynamic index-guided hydration method for patients with congestive heart failure (CHF) and chronic kidney disease (CKD) to reduce the risk of contrast-induced nephropathy (CIN) and at the same time to avoid the acute heart failure.
  
  
  BACKGROUND
  Patients at moderate or high risk for CIN should receive sufficient hydration before contrast application.
  
  
  METHODS
  This prospective, randomized, double-blind, comparative clinical trial enrolled 264 consecutive patients with CKD and CHF undergoing coronary procedures. These patients were randomly assigned to either central venous pressure (CVP)-guided hydration group (n = 132) or the standard hydration group (n = 132). In the CVP-guided group, the hydration infusion rate was dynamically adjusted according to CVP level every hour. CIN was defined as an absolute increase in serum creatinine (SCr) >0.5 mg/dl (44.2 μmol/l) or a relative increase >25% compared with baseline SCr.
  
  
  RESULTS
  Baseline characteristics were well-matched between the 2 groups. The total mean volume of isotonic saline administered in the CVP-guided hydration group was significantly higher than the control group (1,827 ± 497 ml vs. 1,202 ± 247 ml; p < 0.001). CIN occurred less frequently in CVP-guided hydration group than the control group (15.9% vs. 29.5%; p = 0.006). The incidences of acute heart failure during the hydration did not differ between the 2 groups (3.8% vs. 3.0%; p = 0.500).
  
  
  CONCLUSIONS
  CVP-guided fluid administration can safely and effectively reduce the risk of CIN in patients with CKD and CHF. (Central Venous Pressure Guided Hydration Prevention for Contrast-Induced Nephropathy; NCT02405377).
authors.affiliation: Department of Cardiology, Chinese People's Liberation Army General Hospital, Peking, China. Electronic address: qiangeng9396@263.net.
authors.forename: Geng
authors.initials: G
authors.lastname: Qian
authors.affiliation: Department of Cardiology, Chinese People's Liberation Army General Hospital, Peking, China.
authors.forename: Zhenhong
authors.initials: Z
authors.lastname: Fu
authors.affiliation: Department of Cardiology, Chinese People's Liberation Army General Hospital, Peking, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Guo
authors.affiliation: Department of Cardiology, Chinese People's Liberation Army General Hospital, Peking, China.
authors.forename: Feng
authors.initials: F
authors.lastname: Cao
authors.affiliation: Department of Cardiology, Chinese People's Liberation Army General Hospital, Peking, China. Electronic address: cyundai@vip.163.com.
authors.forename: Yundai
authors.initials: Y
authors.lastname: Chen
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000517:prevention & control*; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002496:Central Venous Pressure; D002681:China; D003287:Contrast Media / Q000009:adverse effects*; D003404:Creatinine / Q000097:blood; D004311:Double-Blind Method; D005260:Female; D005440:Fluid Therapy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D006333:Heart Failure / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology; D006801:Humans; D007552:Isotonic Solutions; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology; D012307:Risk Factors; D012965:Sodium Chloride / Q000008:administration & dosage* / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D003287:Contrast Media; D007552:Isotonic Solutions; D012965:Sodium Chloride; D003404:Creatinine
keywords: congestive heart failure; contrast-induced nephropathy; hydration