Impact of left ventricular end diastolic pressure guided hydration on prevention of contrast induced nephropathy post cardiac catheterization

BackgroundContrast induced nephropathy (CIN) is an important complication of cardiac catheterization. Adequate hydration is the simplest and most effective way of protecting renal function. This study was designed to determine whether left ventricular end diastolic pressure (LVEDP). Guided hydration would be superior to routine hydration in patients at risk for CIN undergoing cardiac catheterization.MethodsProspective randomized trial including 200 patients at Alexandria main university hospital.Laboratory investigationSerum urea, creatinine, eGFR by the MDRD equation, Echocardiographic measurement of the left ventricular filling pressure (LVFP) using the ratio (E/septal è). LVEDP measured systematically (in mmHg) using a pigtail catheter. Patients were randomized in a 1:1 fashion to either LVEDP-guided hydration (group 1) or standard hydration (group 2). The primary endpoint was 25% or 0.5 mg/dl or more increase in SCr (two values measured on days 1 and 4), the secondary endpoints were major adverse events (death, myocardial infarction and dialysis) occurring within 30 days.ResultsWe found statistically significant difference between the two types of hydration regarding the occurrence of the primary endpoint (p = 0.046). We found no statistically significant difference between the two groups regarding the secondary endpoints. Statistically significant correlation was found between LVEDP prior to contrast administration and that at the end of the procedure (p < 0.001). Statistically significant positive correlation was found between the LVFP and the LVEDP both prior to contrast administration and at the end of the procedure (p < 0.001).ConclusionsLVEDP-guided hydration is superior to standard hydration in prevention of CIN. Hydration can be done based on LVFP in patients with pre-procedure normal LVF and in patients with pre-procedure elevated LVFP but not in those patients with inconclusive LVFP in which hydration should be guided by the invasively measured LVEDP.