Kidney protection strategy lowers the risk of contrast-associated acute kidney injury

• Published in: PloS one 2024-10, Vol.19 (10), p.e0312618
• Main Authors: Jong, Chien-Boon, Kuo, Jui-Cheng, Lin, I-Chuan
• Format: Article
• Language: English
• Subjects: Acute coronary syndromes; Acute Kidney Injury - chemically induced; Acute Kidney Injury - prevention & control; Aged; Aged, 80 and over; Angiography; Biology and Life Sciences; Blood pressure; Cardiac Catheterization - adverse effects; Cardiac patients; Catheterization; Comorbidity; Confidence intervals; Congestive heart failure; Contrast agents; Contrast media; Contrast Media - adverse effects; Coronary Angiography - adverse effects; Coronary artery bypass; Coronary vessels; Creatinine; Creatinine - blood; Dialysis; Diastolic pressure; Emergency procedures; Epidermal growth factor receptors; Female; Glomerular Filtration Rate; Health aspects; Heart failure; Heart rate; Hemodialysis; Humans; Hydration; Intubation; Kidney diseases; Kidneys; Male; Medical research; Medicine and Health Sciences; Medicine, Experimental; Middle Aged; Mortality; Myocardial infarction; Physical Sciences; Regression analysis; Retrospective Studies; Risk Factors; Risk groups; Statistical analysis; Strategy; Subgroups; Variables; Veins & arteries; Ventricle
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0312618

We developed a comprehensive kidney protection strategy (KPS), which comprises left ventricular end-diastolic pressure-guided saline hydration, ultralow contrast coronary angiography, and a staged coronary revascularization procedure under suitable conditions. This study aimed to investigate KPS's effect on the risk of developing contrast-associated acute kidney injury (CA-AKI) among persons with moderate-to-advanced kidney insufficiency (KI). Seventy patients who had undergone cardiac catheterization with an estimated glomerular filtration rate (eGFR) of 15-45 mL/min/1.73 m2 were investigated retrospectively. Among these, 19 patients who had received KPS and 51 who had undergone cardiac catheterization with usual care (UC) were enrolled. CA-AKI was defined as a 0.3-mg/dL increase in serum creatinine levels or dialysis initiation within 72 h after contrast exposure. The inverse probability of treatment weighting (IPTW)-adjusted cohort was analyzed according to the Mehran 2 risk categories. Patients' mean age was 73.3 ± 9.6 years; mean eGFR was 29.8 ± 8.5 mL/min/1.73 m2; and median of Mehran 2 risk score, 8. Most patients presented with acute myocardial infarction (AMI) or heart failure, and one-fifth of the administered cardiac catheterizations were emergency procedures. After the IPTW adjustment, the KPS group showed a significantly lower CA-AKI risk than the UC group (4% vs. 20.4%; odds ratio 0.19, 95% confidence interval 0.05-0.66). This effect was consistent across various subgroups according to different variables, including old age, AMI, advanced KI, high-risk category, left ventricular systolic dysfunction, and multivessel disease. Conclusively, KPS may reduce the CA-AKI risk in high-risk patients with moderate-to-advanced KI who have undergone cardiac catheterization.