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