Prevention of post procedural acute kidney injury in the catheterization laboratory in a real-world population. (1st January 2017)

• Record Type: Journal Article
• Authors: Chorin, Ehud; Ben-Assa, Eyal; Konigstein, Maayan; Rofe, May-Tal; Hochstadt, Aviram; Galli, Naama; Schnapper, Michael; Arbel, Yaron; Rabey, Ilan; Shoshan, Jeremy Ben; Halkin, Amir; Herz, Itzhak; Finkelstein, Ariel; Bazan, Samuel; Keren, Gad; Banai, Shmuel
• Is Part Of: International journal of cardiology. Volume 226(2017)
• Page Start: 42
• Page End: 47
• Publication Date: 2017-01-01
• Subjects: AKI Acute kidney injury -- CI-AKI Contrast-induced acute kidney injury -- CKD Chronic kidney disease -- CHF Congestive heart failure -- Cr Creatinine -- DM Diabetes mellitus -- eGFR Estimated glomerular filtration rate -- FMH Furosemide-induced diuresis with matched intravenous hydration -- IHD Ischemic heart disease -- PCI Percutaneous coronary intervention -- TAVR Transcatheter aortic valve replacement -- UFR Urine flow rate; Contrast-induced acute kidney injury -- Forced diuresis -- RenalGuard -- Renal failure -- Contrast media; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2016.10.028
• Languages: English
• ISSNs: 0167-5273

Abstract

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). Objectives: 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 37 ml/min per 1.73 m 2 at baseline to 39 ml/min per 1.73 m 2 ( p < 0.001); the net creatinine decreased from 1.85 mg/dl to 1.78 mg/dl ( p < 0.001). Among the matched control group, eGFR deteriorated from a baseline value of 36.7 ml/min per 1.73 m 2 to 33.2 ml/min per 1.73 m 2 post procedurally ( p < 0.001); the net creatinine increased from 1.88 mg/dl to 2.14 mg/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.