Author + information
- Received January 21, 2020
- Revision received March 19, 2020
- Accepted April 7, 2020
- Published online September 7, 2020.
- Carlo Briguori, MD, PhDa,∗ (, )
- Carmen D’Amore, MDa,
- Francesca De Micco, MDa,
- Nicola Signore, MDb,
- Giovanni Esposito, MD, PhDc,
- Gabriella Visconti, MDa,
- Flavio Airoldi, MDd,
- Giuseppe Signoriello, MDe and
- Amelia Focaccio, MDa
- aInterventional Cardiology Unit, Mediterranea Cardiocentro, Naples, Italy
- bInterventional Cardiology Unit, Policlinico di Bari, Bari, Italy
- cDepartment of Advanced Biomedical Science, Division of Cardiology, “Federico II” University of Naples, Naples, Italy
- dInterventional Cardiology Unit, Istituto di Ricerca a Carattere Scientifico Multimedica MultiMedica, Sesto San Giovanni, Milan, Italy
- eDepartment of Mental Health and Preventive Medicine, Second University of Naples, Naples, Italy
- ↵∗Address for correspondence:
Dr. Carlo Briguori, Interventional Cardiology Unit, Mediterranea Cardiocentro, Via Orazio 2, I-80121, Naples, Italy.
Objectives This study compared left ventricular end-diastolic pressure (LVEDP)–guided and urine flow rate (UFR)-guided hydration.
Background Tailored hydration regimens improve the prevention of contrast-associated acute kidney injury (CA-AKI).
Methods Between July 15, 2015, and June 6, 2019, patients at high risk for CA-AKI scheduled for coronary and peripheral procedures were randomized to 2 groups: 1) normal saline infusion rate adjusted according to the LVEDP (LVEDP-guided group); and 2) hydration controlled by the RenalGuard System in order to reach UFR ≥300 ml/h (UFR-guided group). The primary endpoint was the composite of CA-AKI (i.e., serum creatinine increase ≥25% or ≥0.5 mg/dl at 48 h) and acute pulmonary edema (PE). Major adverse events (all-cause death, renal failure requiring dialysis, PE, and sustained kidney injury) at 1 month were assessed.
Results The primary endpoint occurred in 20 of 351 (5.7%) patients in the UFR-guided group and in 36 of 351 (10.3%) patients in the LVEDP-guided group (relative risk [RR]: 0.560; 95% confidence interval [CI]: 0.390 to 0.790; p = 0.036). CA-AKI and PE rates in the UFR-guided group and LVEDP-guided group were 5.7% and 10.0% (RR: 0.570; 95% CI: 0.300 to 0.960; p = 0.048), and, respectively, 0.3% and 2.0% (RR: 0.070; 95% CI: 0.020 to 1.160; p = 0.069). Three patients in the UFR-guided group experienced complications related to the Foley catheter. Hypokalemia rate was 6.2% in the UFR-guided group and 2.3% in the LVEDP-guided group (p = 0.013). The 1-month major adverse events rate was 7.1% in the UFR-guided group and 12.0% in the LVEDP-guided group (p = 0.030).
Conclusions The study demonstrates that UFR-guided hydration is superior to LVEDP-guided hydration to prevent the composite of CA-AKI and PE.
Guerbet (Villepinte, France) supported this study with an unrestricted grant provided to the Mediterranea Cardiocentro, but had no role in study design, data collection, analysis, interpretation, or writing of this report. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Cardiovascular Interventions author instructions page.
- Received January 21, 2020.
- Revision received March 19, 2020.
- Accepted April 7, 2020.
- 2020 American College of Cardiology Foundation
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