title: Prevention of post procedural acute kidney injury in the catheterization laboratory in a real-world population.
abstract: BACKGROUND
  Radiologists and cardiologists have a remarkably different approach to the clinical importance and to the need for prophylactic treatment of contrast-induced acute kidney injury (CI-AKI).
  
  
  OBJECTIVE
  To evaluate the efficacy of forced diuresis with matched controlled hydration (FMH) in a real-world, high risk population.
  
  
  METHODS
  This is an investigator-driven, single-center, retrospective analysis of prospectively collected data. A total of 150 consecutive patients undergoing coronary angiography, angioplasty or TAVR who were treated with FMH were compared to a matched historical control cohort.
  
  
  RESULTS
  In the FMH treated patients, eGFR improved following the procedure from 37ml/min per 1.73m2at baseline to 39ml/min per 1.73m2(p<0.001); the net creatinine decreased from 1.85mg/dl to 1.78mg/dl (p<0.001). Among the matched control group, eGFR deteriorated from a baseline value of 36.7ml/min per 1.73m2to 33.2ml/min per 1.73m2post procedurally (p<0.001); the net creatinine increased from 1.88mg/dl to 2.14mg/dl (p<0.001). The incidence of post procedural AKI was substantially lower in the FMH treated group (2.7%) compared to the control group (26.7%). By multivariable analysis FMH treatment was independently correlated with reduced incidence of post procedural AKI compared with the control group (OR 0.06, p<0.001). Contrast volume did not correlate with AKI in neither univariate nor multivariate analyses.
  
  
  CONCLUSIONS
  In patients undergoing coronary angiography, angioplasty or TAVR, who are considered high risk to develop post procedural AKI, forced diuresis with matched controlled hydration resulted in a significant net creatinine decrease, eGFR increase and a decrease in the incidence of AKI.
authors: Department of Cardiology, Tel Aviv Medical Center, Israel; Sackler School of Medicine, Tel Aviv University, Israel.
authors: Ehud
authors: E
authors: Chorin
authors: Department of Cardiology, Tel Aviv Medical Center, Israel; Sackler School of Medicine, Tel Aviv University, Israel.
authors: Eyal
authors: E
authors: Ben-Assa
authors: Department of Cardiology, Tel Aviv Medical Center, Israel; Sackler School of Medicine, Tel Aviv University, Israel.
authors: Maayan
authors: M
authors: Konigstein
authors: Department of Cardiology, Tel Aviv Medical Center, Israel; Sackler School of Medicine, Tel Aviv University, Israel.
authors: May-Tal
authors: MT
authors: Rofe
authors: Department of Cardiology, Tel Aviv Medical Center, Israel; Sackler School of Medicine, Tel Aviv University, Israel.
authors: Aviram
authors: A
authors: Hochstadt
authors: Department of Cardiology, Tel Aviv Medical Center, Israel; Sackler School of Medicine, Tel Aviv University, Israel.
authors: Naama
authors: N
authors: Galli
authors: Department of Cardiology, Tel Aviv Medical Center, Israel; Sackler School of Medicine, Tel Aviv University, Israel.
authors: Michael
authors: M
authors: Schnapper
authors: Department of Cardiology, Tel Aviv Medical Center, Israel; Sackler School of Medicine, Tel Aviv University, Israel.
authors: Yaron
authors: Y
authors: Arbel
authors: Department of Cardiology, Tel Aviv Medical Center, Israel; Sackler School of Medicine, Tel Aviv University, Israel.
authors: Ilan
authors: I
authors: Rabey
authors: Department of Cardiology, Tel Aviv Medical Center, Israel; Sackler School of Medicine, Tel Aviv University, Israel.
authors: Jeremy Ben
authors: JB
authors: Shoshan
authors: Department of Cardiology, Tel Aviv Medical Center, Israel; Sackler School of Medicine, Tel Aviv University, Israel.
authors: Amir
authors: A
authors: Halkin
authors: Department of Cardiology, Tel Aviv Medical Center, Israel; Sackler School of Medicine, Tel Aviv University, Israel.
authors: Itzhak
authors: I
authors: Herz
authors: Department of Cardiology, Tel Aviv Medical Center, Israel; Sackler School of Medicine, Tel Aviv University, Israel.
authors: Ariel
authors: A
authors: Finkelstein
authors: Department of Cardiology, Tel Aviv Medical Center, Israel; Sackler School of Medicine, Tel Aviv University, Israel.
authors: Samuel
authors: S
authors: Bazan
authors: Department of Cardiology, Tel Aviv Medical Center, Israel; Sackler School of Medicine, Tel Aviv University, Israel.
authors: Gad
authors: G
authors: Keren
authors: Department of Cardiology, Tel Aviv Medical Center, Israel; Sackler School of Medicine, Tel Aviv University, Israel. Electronic address: shmuelb@tlvmc.gov.il.
authors: Shmuel
authors: S
authors: Banai
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D058186:Acute Kidney Injury / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000517:prevention & control; D015331:Cohort Studies; D017023:Coronary Angiography / Q000009:adverse effects / Q000639:trends; D004231:Diuresis / Q000502:physiology; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000639:trends; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000517:prevention & control; D011446:Prospective Studies; D012189:Retrospective Studies; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects / Q000639:trends
keywords: Contrast media; Contrast-induced acute kidney injury; Forced diuresis; Renal failure; RenalGuard