Abstract
Objective. We aimed to explore the preventive effect of low-dose furosemide administration guided by left ventricular end-diastolic pressure (LVEDP) and B-type natriuretic peptide (BNP) based on adequate hydration on contrast-induced nephropathy (CIN) in patients with percutaneous coronary intervention (PCI). Methods. This parallel randomized clinical trial was conducted at a tertiary hospital in China. A total of 1053 consecutive patients (71.98% men) who underwent PCI at our hospital were enrolled. Pre-PCI plasma BNP levels were recorded. Patients enrolled received a continuous intravenous infusion of normal saline starting 4 h before PCI until 24 h after surgery. LVEDP was measured immediately after surgery. Patients in the control group received intravenous furosemide injection (20 mg). Patients in the experimental group received furosemide if they showed LVEDP ≥15 mmHg, a post-PCI BNP level ≥100 pg/mL, and/or a post-PCI BNP value > 150% of the pre-PCI value. The primary and secondary outcome measures were serum creatinine levels, glomerular filtration rate, and creatinine clearance rate measured before and after PCI. CIN incidence was compared between the two groups. Logistic regression analysis was used to study the risk factors for CIN. Results. CIN incidence was significantly higher in the control group than in the experimental group ( P < 0.05 ). Logistic regression analysis showed that elevated LVEDP and BNP levels were risk factors. As LVEDP increased, the CIN incidence also increased (odds ratio (OR) 1.038, 95% confidence interval (CI) 1.006–1.070). The OR of BNP was 1.001 (95% CI 1.000–1.002). Conclusions. Low-dose furosemide administration guided by LVEDP or BNP is superior to direct low-dose administration on the basis of adequate hydration during PCI. This trial is registered with ChiCTR-IOR-14005250
Highlights
Contrast-induced nephropathy (CIN) is a common complication of coronary intervention therapy [1]
A total of 1053 consecutive patients with coronary artery disease (CAD) who underwent percutaneous coronary intervention (PCI) were enrolled in this clinical trial (Chinese Clinical Trial Registry ChiCTR-IOR-14005250) that was conducted from October 2017 to May 2019. e study was performed at the Second Hospital of Hebei Medical University. e study protocol conformed to the ethical guidelines of the 1975 Declaration of Helsinki, as reflected in a priori approval by the Ethics Committee of Hebei Medical University
Logistic regression analysis showed that increased left ventricular enddiastolic pressure (LVEDP) and B-type natriuretic peptide (BNP) levels were positively correlated with the occurrence of CIN
Summary
Contrast-induced nephropathy (CIN) is a common complication of coronary intervention therapy [1]. CIN is defined as an increase in serum creatinine of more than 25% from the baseline, or a 0.5 mg/dL increase in the absolute serum creatinine value, within 48 hours after administration of contrast agents. In view of its high incidence and long-term adverse effects, researchers have carried out extensive studies on the prevention measures for CIN [2]. Periprocedural hydration is recognized as an effective strategy for preventing CIN [3]. Our previous studies have demonstrated that low-dose furosemide administered with adequate hydration reduces the occurrence of CIN more than hydration alone [4]. It is crucial to assess the sufficiency of hydration, which requires careful monitoring of the effective blood volume in clinical practice
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