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Aggressive Hydration and Contrast-Induced Acute Kidney Injury Following Primary Angioplasty (ATTEMPT): A Prospective, Randomised , Open-Label Trial

33 Pages Posted: 2 Jul 2020

See all articles by Yong Liu

Yong Liu

South China University of Technology - Department of Cardiology

Ning Tan

South China University of Technology - Department of Cardiology

Yong Huo

Peking University - Department of Cardiology

Shi-Qun Chen

South China University of Technology - Department of Cardiology

Jin Liu

South China University of Technology - Department of Cardiology

Yun-Dai Chen

Government of the People's Republic of China - Department of Cardiology

Keng Wu

Guangdong Medical University - Department of Cardiology

Gui-Fu Wu

Sun Yat-sen University (SYSU) - Department of Cardiology

Kai-Hong Chen

Fujian Medical University - Department of Cardiology

Jian-Feng Ye

Government of the People's Republic of China - Department of Cardiology

Yan Liang

Maoming People’s Hospital - Department of Cardiology

Xin-Wu Feng

First People’s Hospital of Zhaoqing - Department of Cardiology

Shao-Hong Dong

Shenzhen People's Hospital - Department of Cardiology

Qi-Ming Wu

Capital Medical University - Department of Cardiology

Xian-Hua Ye

Hangzhou First People’s Hospital - Department of Cardiology

He-Song Zeng

Huazhong University of Science and Technology - Division of Cardiology

Min-Zhou Zhang

Guangdong Provincial Hospital of Chinese Medicine - Department of Cardiology

Min Dai

Mianyang Central Hospital - Department of Cardiology

Chong-yang Duan

Southern Medical University - State Key Laboratory of Organ Failure Research

Guo-Li Sun

South China University of Technology - Department of Cardiology

Yi-Bo He

South China University of Technology - Department of Cardiology

Fei-Er Song

South China University of Technology - Department of Cardiology

Zhao-Dong Guo

South China University of Technology - Department of Cardiology

Ping-Yan Chen

Southern Medical University - State Key Laboratory of Organ Failure Research

Junbo Ge

Fudan University - Shanghai Institute of Cardiovascular Diseases

Ying Xian

Duke University - Duke Clinical Research Institute

Jiyan Chen

Guangdong Academy of Medical Sciences - Department of Cardiology; South China University of Technology - Department of Cardiology

More...

Abstract

Background: Hydration remains the cornerstone prevention of contrast-induced acute kidney injury among high risk patients. However, there is great conflict between long-term preprocedural hydration and shortest door-to-balloon time among patients with ST-elevation myocardial infarction. We aimed to determine the effects of aggressive and targeted hydration on contrast-induced acute kidney injury in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention.

Methods: We did this open-label, randomized controlled trial at 15 teaching hospitals in China. Patients who undergoing primary percutaneous coronary intervention at high risk for contrast-induced acute kidney injury were randomized (1:1) to receive aggressive hydration (preprocedural loading dose of 125/250 mL normal saline within 30 minutes, followed by postprocedural hydration guided by left ventricular end-diastolic pressure for 4 hours and additional hydration until 24 hours after primary percutaneous coronary intervention) or general hydration (≤500 mL normal saline from randomization until 6 hours after primary percutaneous coronary intervention). The primary endpoint is contrast-induced acute kidney injury, defined as a >25% or 0.5 mg/dL increase in serum creatinine from baseline during the first 48-72 hours after primary angioplasty. Postprocedural acute heart failure is the safety endpoint. This trial is registered with ClinicalTrials.gov number, NCT02067195.

Findings: Between July 2014 and May 2018, we enrolled 560 patients, of whom 488 patients (mean age 60.1 years, 414 [84.8%] male) were analysed after excluding 72 patients, and 19 patients were not included in primary endpoint analysis for lacking periprocedural serum creatinine data. Contrast-induced acute kidney injury occurred in 51 of 234 patients (21.8%) in the aggressive hydration group and 73 of 235 patients (31.1%) in the control group. The absolute difference (Aggressive hydration vs general hydration) was -11.9% (95% CI -9.4% to -15.0%). Postprocedural acute heart failure did not differ significantly between the aggressive hydration group and the control group (7.9% vs. 6.9%, P=0.69).

Interpretation: In high-risk patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention, aggressive hydration reduced the risk of contrast-induced acute kidney injury and was generally well tolerated, with no significantly increase in postprocedural acute heart failure. Aggressive and targeted hydration could be a new treatment strategy for patients with ST-elevation myocardial infarction.

Trial Registration Number: This trial is registered with ClinicalTrials.gov number, NCT02067195.

Funding Information: National Science Foundation of China, Beijing Lisheng Cardiovascular Health Foundation and Guangdong Provincial People's Hospital Foundation.

Declaration of Interests: Authors declared no competing interests.

Ethical Approval: The study was approved by Guangdong Provincial People's Hospital institutional review board and regulatory authorities at sites not overseen by Guangdong Provincial People's Hospital.

Keywords: aggressive hydration, contrast-induced acute kidney injury, primary angioplasty

Suggested Citation

Liu, Yong and Tan, Ning and Huo, Yong and Chen, Shi-Qun and Liu, Jin and Chen, Yun-Dai and Wu, Keng and Wu, Gui-Fu and Chen, Kai-Hong and Ye, Jian-Feng and Liang, Yan and Feng, Xin-Wu and Dong, Shao-Hong and Wu, Qi-Ming and Ye, Xian-Hua and Zeng, He-Song and Zhang, Min-Zhou and Dai, Min and Duan, Chong-yang and Sun, Guo-Li and He, Yi-Bo and Song, Fei-Er and Guo, Zhao-Dong and Chen, Ping-Yan and Ge, Junbo and Xian, Ying and Chen, Jiyan, Aggressive Hydration and Contrast-Induced Acute Kidney Injury Following Primary Angioplasty (ATTEMPT): A Prospective, Randomised , Open-Label Trial (4/6/2020). Available at SSRN: https://ssrn.com/abstract=3572863 or http://dx.doi.org/10.2139/ssrn.3572863

Yong Liu

South China University of Technology - Department of Cardiology ( email )

Guangzhou
China

Ning Tan

South China University of Technology - Department of Cardiology

Guangzhou
China

Yong Huo

Peking University - Department of Cardiology

Beijing
China

Shi-Qun Chen

South China University of Technology - Department of Cardiology

Guangzhou
China

Jin Liu

South China University of Technology - Department of Cardiology

Guangzhou
China

Yun-Dai Chen

Government of the People's Republic of China - Department of Cardiology

Beijing
China

Keng Wu

Guangdong Medical University - Department of Cardiology

China

Gui-Fu Wu

Sun Yat-sen University (SYSU) - Department of Cardiology

China

Kai-Hong Chen

Fujian Medical University - Department of Cardiology

Longyan
China

Jian-Feng Ye

Government of the People's Republic of China - Department of Cardiology

Dongguan
China

Yan Liang

Maoming People’s Hospital - Department of Cardiology

China

Xin-Wu Feng

First People’s Hospital of Zhaoqing - Department of Cardiology

Zhaoqing
China

Shao-Hong Dong

Shenzhen People's Hospital - Department of Cardiology

Shenzhen
China

Qi-Ming Wu

Capital Medical University - Department of Cardiology

Beijing
China

Xian-Hua Ye

Hangzhou First People’s Hospital - Department of Cardiology

Hangzhou
China

He-Song Zeng

Huazhong University of Science and Technology - Division of Cardiology

1095# Jiefang Ave.
Wuhan, 430030
China

Min-Zhou Zhang

Guangdong Provincial Hospital of Chinese Medicine - Department of Cardiology

Guangzhou
China

Min Dai

Mianyang Central Hospital - Department of Cardiology

China

Chong-yang Duan

Southern Medical University - State Key Laboratory of Organ Failure Research

China

Guo-Li Sun

South China University of Technology - Department of Cardiology

Guangzhou
China

Yi-Bo He

South China University of Technology - Department of Cardiology

Guangzhou
China

Fei-Er Song

South China University of Technology - Department of Cardiology

Guangzhou
China

Zhao-Dong Guo

South China University of Technology - Department of Cardiology

Guangzhou
China

Ping-Yan Chen

Southern Medical University - State Key Laboratory of Organ Failure Research

China

Junbo Ge

Fudan University - Shanghai Institute of Cardiovascular Diseases ( email )

China

Ying Xian

Duke University - Duke Clinical Research Institute

2400 Pratt Street
Durham, NC 27705
United States

Jiyan Chen (Contact Author)

Guangdong Academy of Medical Sciences - Department of Cardiology ( email )

China

South China University of Technology - Department of Cardiology ( email )

Guangzhou
China

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