Incidence of contrast nephropathy in patients receiving comprehensive intravenous and oral hydration

Abstract

Background: Contrast-induced nephropathy (CIN) remains a major complication of percutaneous coronary interventions (PCI) and a common cause of acute renal failure. The most effective preventive strategy is unknown.

Objectives: This study sought to estimate the incidence of CIN in patients receiving comprehensive intravenous and oral volume supplementation for PCI during which iopromide (Ultravist 370, Schering, Berlin, Germany) was used.

Methods: We prospectively studied the development of CIN in 425 consecutive patients undergoing PCI, applying comprehensive intravenous and oral hydration in all patients. Baseline renal function was assessed by calculating the glomerular filtration rate (GFR) with the use of the abbreviated Modification of Diet in Renal Disease Study equation. CIN was defined as an increase in serum creatinine of at least 0.5 mg/dl (44 mmol/l) within 48 hours.

Results: Mean patients' age (mean +/- SD) was 64 +/- 10 years. A total of 133/425 patients (31%) were 70 years or older, 107 (25%) were women, 70 (16%) were diabetics, 218 (51%) had prior myocardial infarction, and 43 (10%) underwent PCI for an acute ST-segment elevation myocardial infarction. Mean GFR was 89 ml/min/1.73 m2. Glomerular filtration rate was below 60 ml/min/ 1.73 m2 in 43 patients (10%). During PCI 226 +/- 80 ml of iopromide were used. With the comprehensive hydration strategy used, CIN developed in only 6 of 425 (1.4%; 95% confidence interval 0.5-3.1%) patients. No patient required dialysis.

Conclusions: Applying the combination of intravenous and oral volume supplementation results in a very low incidence of CIN following PCI. Hydration remains the cornerstone for the prevention of CIN.