Background and AimsContrast‐associated acute kidney injury (CA‐AKI) is a major complication following coronary procedures. We aimed to evaluate the effectiveness of a combination of urine flow rate‐(UFR) guided hydration (RenalGuardTM) and device‐based contrast media (CM) reduction (DyeVertTM) in CA‐AKI prevention.MethodsStable high‐risk patients undergoing coronary procedures with the use of DyeVertTM and RenalGuardTM were prospectively included (Combined group) and matched with a similar cohort of patients treated only with RenalGuardTM in whom CM volume was controlled by operator‐dependent strategies (Control group). CA‐AKI was defined as a serum creatinine increase ≥0.3 mg/dL at 48 h.ResultsOverall, 55 patients were enrolled and matched with comparable controls. Patients in the Combined group were exposed to a lower CM dose (Control: 55 [30–90] mL vs. Combined: 42.1 [24.9–59.4] mL; p = 0.024). A significant interaction was found between treatment allocation and serum creatinine changes (p = 0.048). CA‐AKI occurred in five (9.1%) patients in the Combined group and in 14 (25.4%) patients in the Control group (OR 0.29, 95% CI [0.09–0.88]).ConclusionsA combined strategy of device‐based CM reduction plus UFR‐guided hydration is superior to operator‐dependent CM sparing strategies plus UFR‐guided hydration in preventing CA‐AKI in high‐risk patient.

中文翻译：

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基于设备的对比度最小化和尿流量引导水化的组合策略预防接受冠状动脉介入手术的高危患者的急性肾损伤


背景和目的对比相关急性肾损伤（CA-AKI）是冠状动脉手术后的主要并发症。我们的目的是评估尿流率 (UFR) 引导水化 (RenalGuardTM) 和基于装置的造影剂 (CM) 减少 (DyeVertTM) 组合在预防 CA-AKI 中的有效性。前瞻性地纳入 DyeVertTM 和 RenalGuardTM 的使用（联合组），并与仅使用 RenalGuardTM 治疗的类似患者队列进行匹配，其中 CM 体积通过操作者依赖性策略控制（对照组）。 CA-AKI 被定义为 48 小时时血清肌酐增加≥0.3 mg/dL。 结果总体而言，纳入了 55 名患者并与可比较的对照进行匹配。联合组患者接受较低的 CM 剂量（对照：55 [30-90] mL 对比联合组：42.1 [24.9-59.4] mL；p = 0.024）。治疗分配和血清肌酐变化之间存在显着的相互作用（p = 0.048）。联合组中有 5 名 (9.1%) 患者发生 CA-AKI，对照组有 14 名 (25.4%) 患者发生 CA-AKI（OR 0.29，95% CI [0.09–0.88]）。结论基于设备的 CM 减少的联合策略在预防高危患者 CA-AKI 方面，联合 UFR 指导水化优于操作者依赖的 CM 保留策略联合 UFR 指导水化。