Aggressive Hydration Prevents Kidney Injury in STEMI Patients Undergoing pPCI

Aggressive hydration can prevent contrast-induced acute kidney injury (CI-AKI) in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI), according to a randomized controlled study. The study was carried out at 15 teaching hospitals and involved 560 adult patients who were randomly assigned to either aggressive hydration or general hydration treatment.

The aggressive hydration group received a loading dose of normal saline before the procedure, followed by hydration performed for 4 hours under left ventricular end-diastolic pressure guidance and additional hydration until 24 hours after pPCI. The general hydration group received a lower volume of saline over a longer period of time. The primary endpoint of the study was CI-AKI, defined as a >25% or 0.5 mg/dL increase in serum creatinine from baseline during the first 48–72 hours after primary angioplasty.

Results

The results of the study showed that CI-AKI occurred less frequently in the aggressive hydration group than in the general hydration group (21.8% vs 31.1%). Acute heart failure did not significantly differ between the two groups. The study concluded that peri-operative aggressive hydration seems to be safe and effective in preventing CI-AKI among patients with STEMI undergoing pPCI.

Contrast-induced acute kidney injury is a common complication of pPCI that occurs when contrast agents used during the procedure damage the kidneys. CI-AKI can lead to longer hospital stays, increased healthcare costs, and even death. Patients with STEMI are at increased risk of CI-AKI due to the use of contrast agents during pPCI. Therefore, strategies to prevent CI-AKI are crucial for improving outcomes in this patient population.

Hydration is a well-known preventive strategy for CI-AKI, but the optimal hydration protocol remains controversial. The results of this study suggest that aggressive hydration may be more effective than general hydration in preventing CI-AKI in patients with STEMI undergoing pPCI. The study also found that aggressive hydration was safe and did not increase the risk of acute heart failure. The study provides important insights into the optimal hydration protocol for preventing CI-AKI in patients with STEMI undergoing pPCI.

The study's findings have important clinical implications for the management of patients with STEMI undergoing pPCI. Aggressive hydration may be an effective and safe strategy for preventing CI-AKI in this patient population.

Conclusion

This study suggests that aggressive hydration may be more effective than general hydration in preventing CI-AKI in patients with STEMI undergoing pPCI. The study's findings have important clinical implications for the management of patients with STEMI undergoing pPCI, but further studies are needed to confirm these results and to determine the optimal hydration protocol for preventing CI-AKI in this patient population.
__________