The association between post-procedural oral hydration and risk of contrast-induced acute kidney injury among ST-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention.

Abstract

Oral hydration with water may be inexpensive and effective in the prevention of contrast-induced acute kidney injury (CI-AKI), but its efficacy among ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI) remains unknown. This was a prospective, single-center, observational study. We consecutively enrolled 308 STEMI patients undergoing primary PCI. All patients drank unrestricted amounts of fluids freely, whose volume was recorded until 24 hours following primary PCI. Oral hydration volume/weight ratios (OHV/W) were calculated. Adequate oral hydration was defined as a ratio over 12 mL/kg within 24 hours after primary PCI. The primary outcome measure was CI-AKI, defined as a 25% or 0.5 mg/dL increase in serum creatinine from baseline during the first 48-72 hours post-procedure. The association between adequate post-procedural oral hydration and CI-AKI was assessed using multivariable logistic analysis. Post-procedural prophylactic oral hydration was implemented in 90.91% (280/308) of STEMI patients undergoing primary PCI. There were no differences in the sex, age, weight, index blood pressure, LVEF, anemia, diabetes mellitus, contrast volume used during the coronary procedures between groups (P>0.05). The incidence of CI-AKI was much higher in the inadequate oral hydration group (<12 mL/kg) than the adequate group (≥12 mL/kg) (53.57% vs. 21.79%, P=0.0002). Multivariate logistic regression showed adequate oral hydration (≥12 mL/kg) was the independent protective factor associated with CI-AKI (OR =0.349, 95% CI: 0.147-0.828, P=0.0170), after adjusting confounders, including age, female gender, baseline serum creatinine, diabetes mellitus, use of diuretics, congestive heart failure and intravenous hydration volume. Our study determined the association of post-procedural adequate oral hydration on CI-AKI following primary PCI, which was a potential strategy for CI-AKI prevention among patients with STEMI at very high risk.