Prevention of contrast-induced nephropathy by adequate hydration combined with isosorbide dinitrate for patients with renal insufficiency and congestive heart failure.

Geng Qian,Yundai Chen,Wei Dong,Jin Wang,Chang‐Fu Liu,Jun Guo

doi:10.1002/clc.23023

Abstract

Adequate hydration remains the mainstay of contrast-induced nephropathy prevention, and nitrates could reduce cardiac preload. This study aimed to explore the adequate hydration with nitrates for patients with chronic kidney disease (CKD) and congestive heart failure (CHF) to reduce the risk of contrast-induced nephropathy (CIN) and at the same time avoid the acute heart failure. Three hundred and ninty-four consecutive patients with CKD and CHF undergoing coronary procedures were randomized to either adequate hydration with nitrates (n = 196) or to routine hydration (control group; n = 198). The adequate hydration group received continuous intravenous infusion of isosorbide dinitrate combined with intravenous infusion of isotonic saline at a rate of 1.5 mL/kg/h during perioperative period. The definition of CIN was a 25% or 0.5 mg/dL rise in serum creatinine over baseline. This trial is registered with www.clinicaltrials.gov, number NCT02718521. Baseline characteristics were well-matched between the two groups. CIN occurred less frequently in adequate hydration group than the control group (12.8% vs 21.2%; P = 0.018). The incidence of acute heart failure did not differ between the two groups (8 [4.08%] vs 6[3.03%]; P = 0.599). Cumulative major adverse events (death, myocardial infarction, stoke, hospitalization for acute heart failure) during the 90-day follow-up were lower in the adequate hydration with nitrates group (P = 0.002). Adequate hydration with nitrates can safely and effectively reduce the risk of CIN in patients with CKD and CHF.

Highlights

Chronic kidney disease (CKD), hypovolemia, diabetes mellitus, and congestive heart failure (CHF) are well-recognized risk factors for contrastinduced nephropathy (CIN),3–5 and the needs for transient hemodialysis are significantly increased in this high-risk patients
The principal inclusion criteria included: [1] CHF: clinical symptoms of chronic heart failure in the past 1 year, which present with exertional dyspnea or nocturnal paroxysmal dyspnea or orthopnea and with objective laboratory findings, such as left ventricular ejection fraction 500 pg/mL; [2] chronic kidney disease (CKD): estimated glomerular filtration rate < 60 mL/min, according to Modification of Diet in Renal Disease study equation10; [3] patients were scheduled for coronary angiography; [4] signed informed consent
Patients with CHF often have a decreased effective circulatory volume and increased release of vasoconstrictive hormones, which may contribute to medullary hypoxia

Summary

Background

Adequate hydration remains the mainstay of contrast-induced nephropathy prevention, and nitrates could reduce cardiac preload. Hypothesis: This study aimed to explore the adequate hydration with nitrates for patients with chronic kidney disease (CKD) and congestive heart failure (CHF) to reduce the risk of contrastinduced nephropathy (CIN) and at the same time avoid the acute heart failure. The definition of CIN was a 25% or 0.5 mg/dL rise in serum creatinine over baseline. Cumulative major adverse events (death, myocardial infarction, stoke, hospitalization for acute heart failure) during the 90-day follow-up were lower in the adequate hydration with nitrates group (P = 0.002).

| INTRODUCTION

| METHODS

| RESULTS

| DISCUSSION

Findings

| Limitation