Contrast Induced Nephropathy: Efficacy of matched hydration and forced diuresis for prevention in patients with impaired renal function undergoing coronary procedures-CINEMA trial

Aram J Mirza; Kashan Ali; Farhad Huwez; Abdulsalam Y Taha; Farman J Ahmed; Shahow A Ezzaddin; Zana I Abdulrahman; Chim C Lang

doi:10.1016/j.ijcha.2022.100959

Contrast Induced Nephropathy: Efficacy of matched hydration and forced diuresis for prevention in patients with impaired renal function undergoing coronary procedures-CINEMA trial

Int J Cardiol Heart Vasc. 2022 Feb 1:39:100959. doi: 10.1016/j.ijcha.2022.100959. eCollection 2022 Apr.

Authors

Aram J Mirza¹, Kashan Ali², Farhad Huwez³, Abdulsalam Y Taha⁴, Farman J Ahmed¹, Shahow A Ezzaddin⁵, Zana I Abdulrahman⁶, Chim C Lang²

Affiliations

¹ Department of Interventional Cardiology, Slemani Cardiac Hospital, Sulaymaniyah, Region of Kurdistan, Iraq.
² Division of Molecular & Clinical Medicine, School of Medicine, Ninewells Hospital & Medical School, University of Dundee, UK.
³ Royal London Hospital, Hyper-acute Stroke Unit, Whitechapel, London, UK.
⁴ Department of Thoracic and Cardiovascular Surgery, College of Medicine, University of Sulaimani, Sulaymaniyah, Region of Kurdistan, Iraq.
⁵ Department of Family and Community Medicine, College of Medicine, University of Sulaimani, Sulaymaniyah, Region of Kurdistan, Iraq.
⁶ Shorsh General Hospital, Peshmarga Health Foundation, Ministry of Peshmarga, Region of Kurdistan, Iraq.

Abstract

Background: Matched hydration and forced diuresis (MHFD) using the RenalGuard device has been shown to reduce contrast induced nephropathy (CIN) following coronary interventions.

Aim: To evaluate the potential benefits of a non-automated MHFD protocol compared to current hydration protocol in prevention of CIN in patients with CKD.

Methods: A total of 1,205 patients were randomized to either non-automated MHFD group (n = 799) or intravenous hydration control group (n = 406). The MHFD group received 250 ml IV normal saline over 30 min before the coronary procedure followed by 0.5 mg/kg IV furosemide. Hydration infusion rate was manually adjusted to replace the patient's urine output. When urine output rate reached > 300 ml/h, patients underwent coronary procedure. Matched fluid replacement was maintained during the procedure and for 4-hour post-treatment. CIN was defined conventionally as ≥ 25% or ≥ 0.5 mg/dl rise in serum creatinine over baseline.

Results: CIN occurred in 121 of 1,205 (10.0%) patients in our study. With respect to the primary outcome, 64 (8.01%) of the MHFD patients developed CIN compared with 57 (14.04%) of the control group (p < 0.001).

Conclusions: A non-automated MHFD protocol is an effective and safe method for the prevention of CIN in patients with CKD.

Keywords: Contrast media; Contrast-induced nephropathy; Coronary angiography; Matched hydration and forced diuresis; Percutaneous coronary intervention; Renal impairment.