Excessively high hydration volume may not be associated with decreased risk of contrast-induced acute kidney injury after percutaneous coronary intervention in patients with renal insufficiency

Background-no well-defined protocols currently exist regarding the optimal rate and duration of normal saline administration to prevent contrast-induced acute kidney injury (ci-aki) in patients with renal insufficiency. methods and results-hydration volume ratios (hydration volume/weight; hv/w) were calculated in 1406 patients with renal insufficiency (estimated glomerular filtration rate [egfr],< 90 ml/min per 1.73 m2) undergoing percutaneous coronary intervention (pci) with routine speed hydration (1 or 0.5 ml/kg per hour). we investigated the relationship between hydration volume,risk of ci-aki (increase in serum creatinine ≥ 0.5 mg/dl or 25% within 48-72 hours),and prognosis. mean follow-up duration was 2.85±0.88 years. individuals with higher hv/w were more likely to develop ci-aki (quartiles: q1,q2,q3,and q4: 4.3%,6.6%,10.9%,and 15.0%,respectively; p < 0.001). after adjusting 12 confounders,including age,sex,egfr,anemia,emergent pci,diabetes mellitus,chronic heart failure,diuretics,contrast volume,lesions,smoking status,and number of stents,multivariate analysis showed that a higher hv/w ratio was not associated with a decreased ci-aki risk (q2 vs q1: adjusted odds ratio [or],1.13; q3 vs q1: adjusted or,1.51; q4 vs q1: adjusted or,1.87; all p > 0.05) and even increased ci-aki risk (hv/w > 25 ml/kg: adjusted or,2.11; 95% ci,1.24-3.59; p=0.006). additionally,higher hv/w was significantly associated with an increased risk of death (q4 vs q1: adjusted hazard ratio,3.44; 95% ci,1.20-9.88; p=0.022). conclusions-excessively high hydration volume at routine speed might be associated with increased risk of ci-aki and death post-pci in patients with renal insufficiency. © 2016 the authors.