Tailored hydration for the prevention of contrast-induced acute kidney injury after coronary angiogram or PCI: A systematic review and meta-analysis

IF 3.7 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal Pub Date : 2025-01-04 DOI:10.1016/j.ahj.2025.01.002

François Cossette MD , Alexandru Trifan , Gabriel Prévost-Marcotte MD , Gemina Doolub MD, MSc , Derek F. So MD , William Beaubien-Souligny MD, PhD , Dana Abou-Saleh MD , Jean-Francois Tanguay MD , Brian J. Potter MD, CM, SM , Hung Q. Ly MD, SM , Istok Menkovic MD , Tomas Cieza MD , Robert Avram MD, MSc , Alexandra Bastiany MD , Guillaume Marquis-Gravel MD, MSc

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引用次数: 0

Abstract

Background

Contrast-induced acute kidney injury (CI-AKI) is a frequent complication of coronary interventions associated with an increased risk of mortality and morbidity. The optimal intravenous hydration strategy to prevent CI-AKI is not well-established. The primary objective is to determine if a tailored hydration strategy reduces the risk of CI-AKI and of major adverse cardiovascular events (MACE) in patients undergoing coronary angiography compared with a nontailored hydration strategy.

Methods

A study-level meta-analysis of randomized controlled trials comparing tailored versus nontailored hydration strategies for the prevention of CI-AKI (primary outcome) and of MACE (main secondary outcome) in patients undergoing coronary angiography for any indication was performed. Tailored hydration was defined as the administration of intravenous fluids based on patient-specific parameters other than weight only.

Results

A total of 13 studies were included (n = 4,458 participants). The overall risk of bias was moderate. A tailored strategy was associated with a significant reduction in the risk of CI-AKI (RR = 0.56, 95% CI, [0.46-0.69], P < .00001; I² = 26%), and of MACE (RR = 0.57, 95% CI, [0.42-0.78], P = .0005; I² = 12%). A tailored hydration strategy was not associated with a significant reduction in the other prespecified secondary outcomes, except for all-cause mortality (RR = 0.57, 95% CI, [0.35, 0.94], P = .03; I² = 0%). The impact of a tailored strategy on the primary outcome was consistent in sensitivity analyses.

Conclusion

These results suggest that tailored hydration is superior to nontailored hydration in reducing the risk of CI-AKI and MACE in patients undergoing coronary angiography. Future trials are required to identify the optimal tailored hydration strategy.

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预防冠脉造影或PCI后造影剂引起的急性肾损伤的量身补水：一项系统回顾和荟萃分析。

背景：造影剂诱导的急性肾损伤（CI-AKI）是冠状动脉介入治疗的常见并发症，与死亡率和发病率的增加相关。预防CI-AKI的最佳静脉补水策略尚未确定。主要目的是确定与非定制水化策略相比，定制水化策略是否能降低接受冠状动脉造影的患者CI-AKI和主要不良心血管事件（MACE）的风险。方法：对随机对照试验进行研究水平荟萃分析，比较针对任何适应症接受冠状动脉造影的患者，定制和非定制水化策略预防CI-AKI（主要结局）和MACE（主要次要结局）的效果。量身定做的水合作用被定义为根据患者的具体参数给予静脉输液，而不仅仅是体重。结果：共纳入13项研究（n = 4,458名受试者）。总体偏倚风险为中等。量身定制的策略与CI- aki （RR=0.56, 95% CI, [0.46-0.69], p2=26%）和MACE （RR=0.57, 95% CI, [0.42-0.78], p=0.0005）的风险显著降低相关；I2 = 12%)。除了全因死亡率外，量身定制的补水策略与其他预先指定的次要结局的显著降低无关(RR=0.57, 95% CI, [0.35, 0.94], p=0.03；I2 = 0%)。量身定制的策略对主要结局的影响在敏感性分析中是一致的。结论：这些结果表明，在降低冠状动脉造影患者CI-AKI和MACE的风险方面，定制水化优于非定制水化。未来的试验需要确定最佳的定制水化策略。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American heart journal 医学-心血管系统

CiteScore

8.20

自引率

2.10%

发文量

214

审稿时长

38 days

期刊介绍： The American Heart Journal will consider for publication suitable articles on topics pertaining to the broad discipline of cardiovascular disease. Our goal is to provide the reader primary investigation, scholarly review, and opinion concerning the practice of cardiovascular medicine. We especially encourage submission of 3 types of reports that are not frequently seen in cardiovascular journals: negative clinical studies, reports on study designs, and studies involving the organization of medical care. The Journal does not accept individual case reports or original articles involving bench laboratory or animal research.