Optimal hydration volume among high-risk patients with advanced congestive heart failure undergoing coronary angiography

// Shi-Qun Chen 1, 2, * , Yong Liu 1, 3, * , Wei Jie Bei 1, * , Ying Wang 3, * , Chong-Yang Duan 4, * , Deng-Xuan Wu 1, * , Kun Wang 1 , Ping Yan Chen 4 , Ji-Yan Chen 1 , Ning Tan 1 and Li-Wen Li 1 1 Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China 2 Department of Cardiology, Guangdong General Hospital Zhuhai Hospital (Zhuhai Golden Bay Center Hospital), Zhuhai, Guangdong, China 3 The George Institute for Global Health, Sydney, Australia 4 National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Department of Biostatistics, School of Public Health and Tropical Medicine Southern Medical University, Guangzhou, Guangdong, China * These authors contributed equally to this work Correspondence to: Li-Wen Li, email: gdghllw@163.com Ning Tan, email: tanning100@126.com Keywords: heart failure; acute kidney injury; hydration; contrast; coronary angiography Received: May 30, 2017      Accepted: March 10, 2018      Published: May 04, 2018 ABSTRACT We investigated the relationship between weight-adjusted hydration volumes and the risk of developing contrast-induced acute kidney injury (CI-AKI) and worsening heart failure (WHF) and explored the relative safety of optimal hydration volumes in patients with advanced congestive heart failure (CHF) undergoing coronary angiography (CAG) or percutaneous coronary intervention. We included 551 patients with advanced CHF (New York Heart Association class > 2 or history of pulmonary edema) undergoing CAG (follow-up period 2.62 ± 0.9 years). There was a significant association between hydration volume-to-weight ratio (HV/W) (quintile Q1, Q2, Q3, Q4, and Q5) and the incidence of CI-AKI (3.7%, 14.6%, 14.3%, 21.1%, and 31.5%, respectively) and WHF (3.6%, 5.4%, 8.3%, 13.6%, and 19.1%, respectively) (all P-trend 15 mL/kg independently predicted CI-AKI (adjusted odds ratio [OR] 2.33; P = 0.016) and WHF (adjusted OR 2.13; P = 0.018). Moreover, both CI-AKI and WHF were independently associated with increased long-term mortality. Thus, for high-risk patients with advanced CHF undergoing CAG, HV/W > 15 mL/kg might be associated with an increased risk of developing CI-AKI and WHF. The potential benefits of a personalized limitation of hydration volume need further evaluation.