Background: Acute kidney injury (AKI) is a common cause of worsening renal function due to exposure to contrast media and is associated with increased morbidity and mortality, prolonged in-hospital stay and increased costs. Periprocedural hydration combined with forced diuresis using dedicated RenalGuard (RG) system have been shown to reduce risk of AKI in high-risk patients undergoing coronary angiography. Our aim was to assess rates of AKI and its predictors in patients with impaired baseline renal function undergoing invasive coronary or carotid procedure using RG in routine practice.
Methods: The data on 59 consecutive patients with baseline eGFR < 60 mL/min/1.73 m2 scheduled for coronary or carotid angiography using periprocedural hydration with RG were prospectively collected. The primary end point was rate of AKI defined as an increase of ≥0.5 mg/dL in serum creatinine concentration at 48 hours post procedure. The secondary end point was rate of in-hospital dialysis.
Results: Mean age of the study population was 70.2±10.0 years, and the majority were men (42 patients; 71.2%). The mean eGFR was 32.6±11.5 mL/min/1.73 m2 and mean AKI Mehran risk score was 10.9±3.6. The indication for angiography was acute coronary syndrome (39;66.1%). AKI developed in 7 patients (11.9%) patients and 2 patients (3.4%) required in-hospital dialysis. Patients who developed AKI had lower eGFR (23.9±7.9 vs. 23.9±7.9 mL/min/1.73 m2, p=0.03), higher mean Mehran risk score (13.4±1.9 vs. 10.5±3.7 , p=0.05) and a trend towards lower total volume of periprocedural hydration (3309.7±1167.4 vs. 4259.8±1848.6, p=0.06). .
Conclusion: Despite the use of RG system, every 10th patient with impaired baseline renal function undergoing contrast media exposure during coronary or carotid angiography develops AKI. Worse baseline renal function, higher AKI risk score and lower volume of hydration correlate with higher rates of AKI.
