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Intravenous volume expansion to prevent contrast-associated acute kidney injury.
Briguori, Carlo; Di Iorio, Antonietta; Riviezzo, Guido; Scafuri, Stefano; Focaccio, Amelia; Paolucci, Luca; Cavaliere, Valeria; Di Micco, Francesca; Mariano, Enrica; Celotto, Roberto; Valenti, Francesco; Sangiorgi, Giuseppe Massimo; Biondi-Zoccai, Giuseppe.
Afiliación
  • Briguori C; Interventional Cardiology Unit, Mediterranea Cardiocentro, Naples. Email: carlobriguori@clinicamediterranea.it.
  • Di Iorio A; Interventional Cardiology Unit, Mediterranea Cardiocentro, Naples.
  • Riviezzo G; Interventional Cardiology Unit, Mediterranea Cardiocentro, Naples.
  • Scafuri S; Interventional Cardiology Unit, Mediterranea Cardiocentro, Naples.
  • Focaccio A; Interventional Cardiology Unit, Mediterranea Cardiocentro, Naples.
  • Paolucci L; Interventional Cardiology Unit, Mediterranea Cardiocentro, Naples.
  • Cavaliere V; Interventional Cardiology Unit, Mediterranea Cardiocentro, Naples.
  • Di Micco F; Interventional Cardiology Unit, Mediterranea Cardiocentro, Naples.
  • Mariano E; Interventional Cardiology Unit, University of Rome Tor Vergata, Rome, Italy.
  • Celotto R; Interventional Cardiology Unit, University of Rome Tor Vergata, Rome, Italy.
  • Valenti F; Interventional Cardiology Unit, University of Rome Tor Vergata, Rome, Italy.
  • Sangiorgi GM; Interventional Cardiology Unit, University of Rome Tor Vergata, Rome, Italy.
  • Biondi-Zoccai G; Interventional Cardiology Unit, Mediterranea Cardiocentro, Naples; Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy.
J Invasive Cardiol ; 35(11)2023 Nov.
Article en En | MEDLINE | ID: mdl-37992331
OBJECTIVES: Several volume expansion protocols have been proposed to prevent contrast-associated acute kidney injury (CA-AKI). The aim of our study was to seek the ideal intravenous volume expansion to prevent CA-AKI in patients with chronic kidney disease (CKD) undergoing invasive cardiovascular procedures. METHODS: We analyzed 1927 CKD patients enrolled in 6 studies that took place from September 15, 2000 to June 6, 2019. Four volume expansion regiments were included: (1) conventional group (n=625); (2) bicarbonate group (n=255); (3) left ventricular end-diastolic pressure-guided group (n=355); and (4) urine flow rate-guided group (n=500). RESULTS: CA-AKI (serum creatinine increase ≥0.3 mg/dL at 48 hours) occurred in 224 (11%) patients. In patients with CA-AKI, volume expansion was lower (2090 ± 1382 mL vs 2551 ± 1716 mL; P less than .001) and acute pulmonary edema occurred more often (3.5% vs 0.29%; P less than .001). By ROC curve analysis, an absolute volume expansion greater than or equal to 1430 mL (AUC = 0.70) and a volume expansion to contrast media volume ratio greater than or equal to 17 (AUC = 0.57) were the best thresholds for freedom from CA-AKI. CONCLUSIONS: In our comprehensive pooled analysis, an absolute volume expansion greater than or equal to 1430 mL and a volume expansion to contrast media volume ratio greater than or equal to 17 are the best dichotomous thresholds for CA-AKI prevention. These cutoffs should be formally tested in a dedicated trial as a pragmatic means to prevent CA-AKI.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Insuficiencia Renal Crónica / Lesión Renal Aguda Límite: Humans Idioma: En Revista: J Invasive Cardiol Asunto de la revista: CARDIOLOGIA Año: 2023 Tipo del documento: Article Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Insuficiencia Renal Crónica / Lesión Renal Aguda Límite: Humans Idioma: En Revista: J Invasive Cardiol Asunto de la revista: CARDIOLOGIA Año: 2023 Tipo del documento: Article Pais de publicación: Estados Unidos