Author + information
- Received April 13, 2015
- Revision received June 16, 2015
- Accepted September 4, 2015
- Published online January 11, 2016.
- Geng Qian, MD (, )
- Zhenhong Fu, MD,
- Jun Guo, MD,
- Feng Cao, MD and
- Yundai Chen, MD∗ ()
- ↵∗Reprint requests and correspondence:
Dr. Yundai Chen, Chinese People's Liberation Army General Hospital, 100853 Peking, China.
Objectives This study aimed to explore the hemodynamic index–guided hydration method for patients with congestive heart failure (CHF) and chronic kidney disease (CKD) to reduce the risk of contrast-induced nephropathy (CIN) and at the same time to avoid the acute heart failure.
Background Patients at moderate or high risk for CIN should receive sufficient hydration before contrast application.
Methods This prospective, randomized, double-blind, comparative clinical trial enrolled 264 consecutive patients with CKD and CHF undergoing coronary procedures. These patients were randomly assigned to either central venous pressure (CVP)-guided hydration group (n = 132) or the standard hydration group (n = 132). In the CVP-guided group, the hydration infusion rate was dynamically adjusted according to CVP level every hour. CIN was defined as an absolute increase in serum creatinine (SCr) >0.5 mg/dl (44.2 μmol/l) or a relative increase >25% compared with baseline SCr.
Results Baseline characteristics were well-matched between the 2 groups. The total mean volume of isotonic saline administered in the CVP-guided hydration group was significantly higher than the control group (1,827 ± 497 ml vs. 1,202 ± 247 ml; p < 0.001). CIN occurred less frequently in CVP-guided hydration group than the control group (15.9% vs. 29.5%; p = 0.006). The incidences of acute heart failure during the hydration did not differ between the 2 groups (3.8% vs. 3.0%; p = 0.500).
Conclusions CVP-guided fluid administration can safely and effectively reduce the risk of CIN in patients with CKD and CHF. (Central Venous Pressure Guided Hydration Prevention for Contrast-Induced Nephropathy; NCT02405377)
This study was funded by Chinese People's Liberation Army General Hospital, Chinese People's Liberation Army Postgraduate Medical School, Peking, China. The funding source (14KMM02) had no role in study design, data collection, analysis, interpretation, or reporting. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received April 13, 2015.
- Revision received June 16, 2015.
- Accepted September 4, 2015.
- 2016 American College of Cardiology Foundation