Short period of high-volume IV fluid acceptable prophylaxis for AKI after angiography
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One liter of IV fluid can be administered prophylactically to patients over a short period (< 6 hours) following angiography to prevent adverse renal outcomes, according to a speaker at ASN Kidney Week.
“Our goal was to define practical fluid administration targets,” Qandeel H. Soomro, MD, from New York University Langone Health, said. “We aimed to determine if higher volumes (higher than 1,000 mL) of fluid given over shorter durations (less than 6 hours) were effective prophylaxis for reducing the risk of 90-day adverse renal outcomes and of contrast associated AKI (CA-AKI).”
In a secondary analysis of 4,993 PRESERVE participants, researchers divided patients into quartiles by total fluid volume. All patients were randomized to either IV saline or IV bicarbonate prophylaxis.
Using logistic regression, researchers conducted a multivariable analysis adjusted for age, history of heart failure, diabetes mellitus, left ventricular end-diastolic pressure, baseline glomerular filtration rate, procedure type, inpatient vs. outpatient status and duration.
Additionally, researchers measured the interaction between fluid volume and duration of fluid administration categorized as less than 6 hours or at least 6 hours.
Quartile 1 received a mean of 701 mL of fluid over a mean of 6.9 hours; quartile 2 received a mean of 964 mL of fluid over a mean of 7.9 hours; quartile 3 received a mean of 1,140 mL of fluid over a mean of 8.2 hours; and quartile 4 received a mean of 1,478 mL of fluid over a mean of 9.6 hours.
The primary outcomes of the study were death, the need for dialysis or a persistent serum creatinine level increase of at least 50% from baseline in at least 90 days. The secondary outcome was CA-AKI.
Analyses revealed a significantly increased risk of the primary 90-day endpoint in quartile 1, compared with the highest quartile (Q4) of fluid volume. There were no differences between quartile 2 and 3 when compared with quartile 4. No significant interaction occurred between volume and duration of fluid administration, nor was there a significant difference in the occurrence of CA-AKI across the groups.
“In conclusion, we highlight a practical approach to facilitate outpatient procedures with easily implemented intravenous fluid administration targets. Our results suggest that for the majority of patients, a mean fluid volume of 1 liter over short duration (less than 6 hours) is an acceptable target for prophylactic fluid administration for prevention of adverse renal outcomes,” Soomro said. “However, only a randomized controlled trial can prove the safety of administering larger volumes of fluid in patients similar to those in quartile 1.”
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Soomro QH, et al. The relationship between intravenous fluid administration and renal outcomes after angiography. Presented at: ASN Kidney Week; Nov. 4-7, 2021 (virtual meeting).
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