Abstract 19702: Excessive Hydration Volume Tends to be Associated With a Higher Risk of Contrast-induced Nephropathy After Percutaneous Coronary Intervention in Patients With Chronic Kidney Disease

Abstract

Introduction: Adequate hydration with isotonic saline is generally recommended to prevent contrast-induced nephropathy (CIN) in patients with chronic kidney disease (CKD). However, no well-defined protocols regarding the optimal rate and duration of normal saline administration currently exist. Hypothesis: Higher intravascular hydration volume of normal saline adjusted by weight (hydration volume/weight [HV/W], mL/kg) can reduce the risk of CIN in patients with CKD undergoing percutaneous coronary intervention (PCI). Methods: Patients with CKD (creatinine clearance [CrCl] <90 mL/min/1.73 m2) undergoing PCI with hydration at the speed recommended by the current guidelines (1 mL/kg/h [0.5 mL/kg/h for left ventricular ejection fraction <40% or severe congestive heart failure]) were included in the study (n=1406). Results: Individuals with higher HV/W ratios were more likely to develop CIN (Q1, Q2, Q3, and Q4: 4.3%, 6.6%, 10.9%, and 15.0%, respectively; P<0.001) and acute heart failure (0.29%, 2.28%, 2.73%, and 5.01%, respectively; P=0.001), and were associated with higher in-hospital costs (8,314, 8,634, 9,274, 10,073 dollars, respectively; P25 mL/kg), the adjusted OR was 1.93 (95% CI: 1.09~3.42; P=0.025). Additionally, higher hydration was significantly associated with an increased risk of death (Q2 vs. Q1: adjusted hazard ratio [HR]: 3.59, 95% CI: 1.19~10.84; Q3 vs. Q1: adjusted HR: 3.51, Q4 vs. Q1: adjusted HR: 4.29, P<0.05). Conclusions: Excessive intravascular hydration volume at routine speed was associated with higher risks of CIN, acute heart failure, and death, as well as increased health care costs.