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Role of Hydration in Contrast-Induced Nephropathy

in Patients Who Underwent Primary Percutaneous


Coronary Intervention

Annis Rakhmawati

Identitas Jurnal
Judul : Role of Hydration in ContrastInduced Nephropathy in Patients Who
Underwent Primary Percutaneous
Coronary Intervention
Penulis : Alfonso Jurado-Romn et al
Publikasi
:
Am
2015;115:1174-1178

Cardiol

INTRODUCTION
The incidence of CIN in Primary PCI (PPCI) for
STEMI patient is higher than in elective
procedures.
There is no preventive strategy has been
recommended by current guidelines for
STEMI who underwent PPCI
The aim to evaluate the possible beneficial
role of periprocedural i.v isotonic saline
in STEMI patient who underwent PPCI

Subjects
Inclusion Criteria
All STEMI patients who underwent PPCI
July 2012 to November 2013 at their
institution (Cardiology Department, Madrid,
Spain)

Exclusion Criteria:
end-stage renal failure requiring dialysis
cardiac arrest
severe heart failure (Killip III to IV)

Methods
Prospective, single-center, randomized study
to investigate the role of hydration to
prevent CIN in STEMI patient who underwent
PPCI.
All patients received an iso-osmolar nonionic
contrast medium (iodixanol).
Primary end point the development of CIN
25% or 0.5 mg/dl increase in serum
creatinine within 3 days post procedural.

Categorical variables were analyzed


by the chi-square analysis or Fishers
exact test.
Independent t test and Wilcoxon
tests were used to determine
differences between normal and nonnormally distributed quantitative
variables

Multivariate logistic regression


analysis to identify independent
predictors of CIN.
Significant crossover rate was
expected exploratory analysis &
an intention-to-treat analysis.
All analyses were performed with
SPSS 20.0

Baseline Characteristics

Procedural Characteristics

RESULT

Discussion
In STEMI with elective PCI, i.v hydration
is simple & effective to prevent CIN.
Not only patients with CKD have CIN
variety of other risk factors facilitate CIN
in patients with normal renal function
Current guidelines havent still
suggested definite recommendations
about CIN prevention in PPCI

Marenzi et al the use of


postprocedural hydration with saline
solution in STEMI underwent PPCI.
Merten et al rapid preprocedural
infusion of sodium bicarbonate in
elective PCI.

Maioli et al hydrated patients had


higher reductions of creatinine. The
sooner the better results.
This study use 2 different hydration
sodium bicarbonate and saline solution.
Important finding 960 ml of fluids in
CIN prevention

Prevention of Contrast-Induced Nephropathy With N-Acetylcysteine or


Sodium Bicarbonate in Patients With ST-SegmenteMyocardial
Infarction (CINSTEMI) trial

Thayssen et al
Prevention with NAC, NaHCO3, or the
combined NAC+NaHCO3 didnt
reduce the rate of CIN significantly
compared with hydration with i.v
NaCl infusion alone

Study limitation
Single-center study without blinding
& small sample size
The significant crossover rate
between both treatment groups
expected limitation an intentionto-treat analysis was performed

Standard of GFR formula can be overridden by the acute conditions


fluctuation in creatinine values.
The simple laboratory definition of
CIN cant exclude acute tubular
necrosis & cardiorenal syndrome.

Conclusion
i.v saline hydration during PPCI
reduced the risk of CIN to 48%.
Patients with CIN had increased
mortality and need for dialysis.
Preventive hydration should be given
to STEMI patients underwent PPCI.

Critical Appraisal
Are the results Valid
1. Was the assignment of patients to treatments randomized? And
was the randomization list concealed? yes
2. Was follow-up of patients sufficiently long and complete? yes
3. Were patients analyzed in the groups which they were randomized?
yes
4. Were patients and clinicians kept blind to treatment? no
5. Were the groups treated equally, apart from the experimental
treatment? yes
6. Were the groups similar at the start of the trial? yes

Are the valid results of this


randomized study important?
What is the magnitude of the
treatment effect?
RRR = 48,8%

Are these valid, important


results applicable to our
patient?

1. Is our patient so different from those in the study that


its results cannot apply? No
2. Is the treatment feasible in our setting? Yes
3. What are our patients potential benefits and harms
form the therapy?
Benefit: reduce the risk of CIN in patients with STEMI
underwent PPCI with an easy, cheap, and safe
preventive strategy.
Harm : Has not been proved as gold standard therapy

Thank you