Similar kidney outcomes found between IV volume, duration after angiography
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Risk of adverse kidney outcomes after angiography with IV fluid volumes of at least 1L administered in a period of 6 hours was similar to that found for higher volumes with fluid administration durations longer than 6 hours, research shows.
“The results confirm the utility of the commonly used fluid ‘recipe’ of 3 mL/kg for 1 hour prior to the procedure and 1 mL/kg per hour during the procedure and for 6 hours after,” James S. Kaufman, MD, professor in the department of medicine at NYU Grossman School of Medicine and co-author of the study, told Healio. “Although this observational study doesn’t provide definitive information, it does suggest that this regimen may safely be used to facilitate outpatient angiographic procedures.”
In a post hoc analysis of the PRESERVE trial, researchers studied 4,671 patients from the trial who underwent angiographic procedures. Researchers sought to determine if periprocedural fluid administration was related to the risk of contrast-associated AKI and 90-day adverse outcomes, according to fluid volume and duration of fluid administration.
Researchers classified contrast-associated AKI as “an increase in serum creatinine of at least 25% or 0.5 mg/dL from baseline at 3 to 5 days after angiography.”
Methods
Patients were categorized into four quartiles according to total fluid volume, including before, during and after angiography, to show differences in a range of volumes. Quartile 1 included a range of 89 mL to 882 mL; quartile 2 included 883 mL to 1,034 mL; quartile 3 included 1,035 mL to 1,257 mL; and quartile 4 included 1,258 mL to 2,790 mL.
For study duration, researchers divided it into two categories: less than 6 hours and greater than or equal to 6 hours.
The composite of death, 90-day need for dialysis or a 50% increase in serum creatinine at 90 days after angiography were the primary outcomes, while contrast-associated AKI, individual components of the primary composite outcome and hospitalization with acute coronary syndrome, heart failure or stroke by 90 days were secondary outcomes.
To observe the association between fluid volume with primary and secondary outcomes, multivariable logistic regression models were utilized, and covariates included baseline eGFR and heart failure history.
Results
Researchers found that in adjusted models for age, diabetes, eGFR, inpatient/outpatient status, heart failure history, percutaneous coronary intervention (PCI) and fluid duration, those in quartile 1 had a significantly higher risk of the primary outcome when compared with quartile 4.
With quartile 4 as a reference, the risk of the primary endpoint did not differ in quartiles 2 and 3.
Across quartiles 1, 2 and 3, no difference in the incidence of contrast-associated AKI was found compared with quartile 4. Additionally, fluid volume and duration had no significant relationship for any of the outcomes.
“Although an appropriately powered randomized trial may be difficult to implement, such a trial focusing on the subgroups of patients comprising quartile receiving the lowest volume of fluid, those with a history of heart failure and lower eGFR, and those in the quartile receiving the highest volume of fluid who were more likely to undergo PCI and have diabetes, would be of interest,” Kaufman said. “Can those in the lowest quartile tolerate more fluid without increasing their risk of heart failure, and can those in the highest quartile receive less fluid despite undergoing PCI without increase their risk of contrast-associated AKI?”
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