Prevention of post procedural acute kidney injury in the catheterization laboratory in a real-world population

Background Radiologists and cardiologists have a remarkably different approach to the clinical importance and to the need for prophylactic treatment of contrast-induced acute kidney injury (CI-AKI). Objectives To evaluate the efficacy of forced diuresis with matched controlled hydration (FMH) in a real-world, high risk population. Methods This is an investigator-driven, single-center, retrospective analysis of prospectively collected data. A total of 150 consecutive patients undergoing coronary angiography, angioplasty or TAVR who were treated with FMH were compared to a matched historical control cohort. Results In the FMH treated patients, eGFR improved following the procedure from 37 ml/min per 1.73 m² at baseline to 39 ml/min per 1.73 m² (p < 0.001); the net creatinine decreased from 1.85 mg/dl to 1.78 mg/dl (p < 0.001). Among the matched control group, eGFR deteriorated from a baseline value of 36.7 ml/min per 1.73 m² to 33.2 ml/min per 1.73 m² post procedurally (p < 0.001); the net creatinine increased from 1.88 mg/dl to 2.14 mg/dl (p < 0.001). The incidence of post procedural AKI was substantially lower in the FMH treated group (2.7%) compared to the control group (26.7%). By multivariable analysis FMH treatment was independently correlated with reduced incidence of post procedural AKI compared with the control group (OR 0.06, p < 0.001). Contrast volume did not correlate with AKI in neither univariate nor multivariate analyses. Conclusions In patients undergoing coronary angiography, angioplasty or TAVR, who are considered high risk to develop post procedural AKI, forced diuresis with matched controlled hydration resulted in a significant net creatinine decrease, eGFR increase and a decrease in the incidence of AKI.