Feature | November 08, 2012

Hydration Based on Ventricular Pressure Reduces CIN Kidney Damage From Contrast Agents

Results of the POSEIDON trial pin treating contrast-induced nephropathy presented at TCT 2012

Clinical Study Catherization Kindey Damage Contrast Media

November 8, 2012 — A hydration regimen tailored to the patient’s fluid status was effective in reducing damage to kidneys in patients undergoing cardiac catheterization, according to a study presented at the 24th annual Transcatheter Cardiovascular Therapeutics (TCT) scientific symposium, sponsored by the Cardiovascular Research Foundation (CRF).

Contrast-induced acute kidney injury (CI-AKI), or contrast-induced nephropathy, refers to kidney damage that may occur due to the use of iodine contrast dye that is necessary for visualization during catheterization and other procedures. Hydration remains the cornerstone for the prevention of kidney damage. However, there are no well-defined practical hydration protocols available for the prevention of CI-AKI. The Prevention of Contrast Renal Injury with Different Hydration Strategies (POSEIDON) clinical trial investigated a novel sliding scale hydration protocol based upon routine, invasively obtained left ventricular end-diastolic pressure measurements (LVEDP) in patients undergoing cardiac catheterization.

To see a video of this presentation at TCT, click here.

Patients undergoing coronary angiography with stable renal insufficiency (an estimated GFR <60 mL/min/1.73m2) and one additional CI-AKI risk factor were randomized to an LVEDP-guided hydration strategy or a standard hydration strategy.

Both groups received 0.9 percent saline at 3 mL/kg for at least one hour prior to cardiac catheterization. The LVEDP was measured in all patients at the start of the procedure and prior to contrast administration. In the LVEDP group, the fluid rate was adjusted according to the patients’ LVEDP as follows: 5 mL/kg/hr for LVEDP <13 mmHg; 3 mL/kg/hr for 13-18 mmHg; 1.5 mL/kg/hr for >18 mmHg.

The standard hydration group was hydrated at 1.5 mL/kg/hr. The fluid rate was set at the start of the procedure (prior to contrast exposure), continued during the procedure and for four hours post-procedure. The primary outcome, CI-AKI, was defined as a greater than 25 percent or greater than 0.5 mg/dl increase in serum creatinine — an indicator of kidney damage — up to four days post-procedure.

There were 396 patients randomized, 196 in the LVEDP group and 200 in the standard hydration group. Kidney damage was found in 6.7 percent of the LVEDP-guided hydration group and in 16.3 percent of the standard hydration group (P = 0.005). There were no significant differences between groups for baseline renal function or LVEDP. The relative risk (95 percent confidence interval) for LVEDP-guided hydration versus standard hydration was 0.41 (0.22-0.79). The absolute risk difference was -9.5 percent in favor of LVEDP guided hydration; therefore, 11 patients would need to be treated to prevent one CI-AKI event.

“This is the first trial to test the hypothesis of a left ventricular end diastolic pressure-guided hydration strategy for prevention of contrast nephropathy. We found that this technique resulted in a significant 59 percent relative and 10 percent absolute reduction in contrast nephropathy,” said lead researcher Somjot Brar, M.D., MPH, interventional cardiologist and vascular specialist at Kaiser Permanente in Los Angeles and an assistant clinical professor of medicine at the University of California, Los Angeles. “This is an easily implemented protocol that can be readily adapted in both inpatient and outpatient settings.”

The trial was funded by Kaiser Permanente.

For more information: www.crf.org

Related Content

cardiac surgery, simulation training, University of Washington, case studies

Multiple repetitions of bypass grafts on a heart, using the Ramphal simulator. Courtesy of the University of Washington in Seattle.

News | Cardiovascular Surgery| August 25, 2016
August 25, 2016 — Simulation training fo
aortic dissection, family history, same age, clinical study, John A. Elefteriades, Annals of Thoracic Surgery
News | Structural Heart| August 25, 2016
People with a family member who had an aortic dissection — a spontaneous tear in one of the body’s main arteries —...
Intact Vascular, TOBA clinical study, one-year results, Tack Endovascular System, Journal of Vascular Surgery
News | Peripheral Arterial Disease (PAD)| August 24, 2016
Intact Vascular Inc. announced that the one-year results from its Tack Optimized Balloon Angioplasty (TOBA) clinical...
nanoparticles, blood clotting, internal bleeding, American Chemical Society study, Erin B. Lavik

Nanoparticles (green) help form clots in an injured liver. The researchers added color to the scanning electron microscopy image after it was taken. Image courtesy of Erin Lavik, Ph.D.

News | Hemostasis Management| August 24, 2016
August 24, 2016 — Whether severe trauma occurs on the battlefield or the highway, saving lives often comes down to...
Technavio report, renal denervation devices, 2015
News | Renal Denervation| August 23, 2016
August 23, 2016 — Technavio analysts forecast the global...
News | Heart Failure| August 23, 2016
August 23, 2016 — A new study of more than 13,000 people has found that so-called morbid obesity appears to stand alo
Jason Burdick, injectable hydrogels, heart failure, heart attack, American Chemical Society

Compared to other types of hydrogels being developed (left), a new hydrogel (right) can form crosslinks after injection into the heart, making the material stiffer and longer-lasting. Image courtesy of American Chemical Society.

News | Heart Failure| August 23, 2016
August 23, 2016 — During a heart attack, clots or narrowed arteries block blood flow, harming or killing cells within
News | Peripheral Arterial Disease (PAD)| August 22, 2016
Avinger Inc. recently announced the closing of its previously announced public offering of 9,857,800 shares of Avinger’...
sleep apnea, hypertension, clinical study, Science Signaling, University of Chicago
News | Hypertension| August 22, 2016
Obstructive sleep apnea is a common cause of high blood pressure. In the Aug. 17, 2016, issue of the journal Science...
DMC Heart Hospital, Detroit Medical Center, complex percutaneous intervention education course, PCI, cath lab training
News | Cath Lab| August 22, 2016
The Detroit Medical Center (DMC) Heart Hospital recently completed a Complex Percutaneous Intervention education course...
Overlay Init