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  • Hydration for prevention of kidney injury after primary coronary intervention for acute myocardial infarction: a randomised clinical trial

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Coronary artery disease
Original research
Hydration for prevention of kidney injury after primary coronary intervention for acute myocardial infarction: a randomised clinical trial
  1. Yong Liu1,2,
  2. Ning Tan1,2,
  3. Yong Huo3,
  4. Shiqun Chen1,2,
  5. Jin Liu1,2,
  6. Yun-Dai Chen4,
  7. Keng Wu5,
  8. Guifu Wu6,
  9. Kaihong Chen7,
  10. Jianfeng Ye8,
  11. Yan Liang9,
  12. Xinwu Feng10,
  13. Shaohong Dong11,
  14. Qiming Wu12,
  15. Xianhua Ye13,
  16. Hesong Zeng14,
  17. Minzhou Zhang15,
  18. Min Dai16,
  19. Chong-Yang Duan17,
  20. Guoli Sun1,2,
  21. Yibo He1,2,
  22. Feier Song1,2,
  23. Zhaodong Guo1,2,
  24. Ping-Yan Chen16,
  25. Junbo Ge18,
  26. Ying Xian19,
  27. Jiyan Chen1,2
  1. 1 Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
  2. 2 Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
  3. 3 Cardiology, Peking University First Hospital, Beijing, China
  4. 4 Cardiology, The First Medical Center, Chinese PLA General Hospital, Beijing, China
  5. 5 Cardiology, The Affiliated Hospital, Guangdong Medical University, Zhanjiang, Guangdong, China
  6. 6 Cardiology, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong, China
  7. 7 Cardiology, Longyan First Affiliated Hospital, Fujian Medical University, Longyan, Fujian, China
  8. 8 Cardiology, Dongguan People’s Hospital, Dongguan, Guangdong, China
  9. 9 Cardiology, Maoming People's Hospital, Maoming, Guangdong, China
  10. 10 Cardiology, The First People's Hospital of Zhaoqing, Zhaoqing, Guangdong, China
  11. 11 Cardiology, Shenzhen People's Hospital, Shenzhen, Guangdong, China
  12. 12 Cardiology, Beijing Ditan Hospital, Capital Medical University, Beijing, China
  13. 13 Cardiology, Hangzhou First People’s Hospital, Hangzhou, Zhejiang, China
  14. 14 Cardiology, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, China
  15. 15 Cardiology, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
  16. 16 Cardiology, Mianyang Central Hospital, Changjia Alley 12, Fucheng District, Mianyang, Sichuan, China
  17. 17 Biostatistics, The State Key Laboratory of Organ Failure Research, The Key Laboratory of Tropical Disease Research, School of Public HealthMedical University, Guangzhou, Guangdong, China
  18. 18 Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China
  19. 19 Neurology, Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
  1. Correspondence to Dr Jiyan Chen, Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, The Affiliated Guangdong Provincial People's Hospital of South China University of Technology, Guangzhou, Guangdong, China; chenjiyandr{at}126.com

Abstract

Objective To evaluate the efficacy of aggressive hydration compared with general hydration for contrast-induced acute kidney injury (CI-AKI) prevention among patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI).

Methods The Aggressive hydraTion in patients with STEMI undergoing pPCI to prevenT Contrast-Induced Acute Kidney Injury study is an open-label, randomised controlled study at 15 teaching hospitals in China. A total of 560 adult patients were randomly assigned (1:1) to receive aggressive hydration or general hydration treatment. Aggressive hydration group received preprocedural loading dose of 125/250 mL normal saline within 30 min, followed by postprocedural hydration performed for 4 hours under left ventricular end-diastolic pressure guidance and additional hydration until 24 hours after pPCI. General hydration group received ≤500 mL 0.9% saline at 1 mL/kg/hour for 6 hours after randomisation. The primary end point is CI-AKI, defined as a >25% or 0.5 mg/dL increased in serum creatinine from baseline during the first 48–72 hours after primary angioplasty. The safety end point is acute heart failure.

Results From July 2014 to May 2018, 469 patients were enrolled in the final analysis. CI-AKI occurred less frequently in aggressive hydration group than in general hydration group (21.8% vs 31.1%; risk ratio (RR) 0.70, 95% CI 0.52 to 0.96). Acute heart failure did not significantly differ between the aggressive hydration group and the general hydration group (8.1% vs 6.4%, RR 1.13, 95% CI 0.66 to 2.44). Several subgroup analysis showed the better effect of aggressive hydration in CI-AKI prevention in male, renal insufficient and non-anterior myocardial infarction participants.

Conclusions Comparing with general hydration, the peri-operative aggressive hydration seems to be safe and effective in preventing CI-AKI among patients with STEMI undergoing pPCI.

  • percutaneous coronary intervention
  • myocardial infarction
  • coronary angiography

Data availability statement

Data are available on reasonable request. Data are available upon reasonable request.

https://doi.org/10.1136/heartjnl-2021-319716

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    Data availability statement

    Data are available on reasonable request. Data are available upon reasonable request.

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    Footnotes

    • YL, NT and YH contributed equally.

    • Correction notice This article has been corrected since it was first published to correct the author affiliations.

    • Contributors P-YC was the senior statistician and JC as scientific lead of GDICA provided guidance for trial management. YL, NT, YH, SC, Y-DC, PYC, JG, YX, KW, GW, KC, JY, YL, XF, SD and C-YD contributed to the design of the study. GS, FS, MD, QW, XY, HZ, MZ and YH recruited patients and collected data. SC and JL did the statistical analyses. YL, JL and ZG wrote the first draft of the manuscript. All authors contributed to interpretation of the data, revision of the report and approved the final manuscript.

    • Funding The ATTEMPT study was funded by the Beijing Lisheng Cardiovascular Health Foundation and the Guangdong Provincial People’s Hospital Foundation (LHJJ20141751, 2014dzx02), National Science Foundation of China (grant no. 81670339 and 81500520), Guangdong Provincial Clinical Research Center for Cardiovascular disease (2020B1111170011) and Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention (2017B030314041). The funders were not involved in trial design, patient recruitment, data collection, analysis, interpretation or presentation, writing or editing of the reports or the decision to submit for publication. The corresponding author had full access to all data in the study and had final responsibility for the decision to submit for publication.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; internally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.