Effects of intravenous hydration on risk of contrast induced nephropathy and in-hospital mortality in STEMI patients undergoing primary percutaneous coronary intervention: a systematic review and meta-analysis of randomized controlled trials

Yong Liu, Daqing Hong, Amanda Ying Wang*, Rui Guo, Brendan Smyth, Jin Liu, Guoli Sun, Shiqun Chen, Ning Tan, Meg Jardine, David Brieger, Ahmed Shaman, Shariful Islam, Jiyan Chen, Martin Gallagher

*Corresponding author for this work

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Abstract

Background: The role of intravenous hydration at the time of primary percutaneous intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) remains unclear. Guidelines are vague, supported by low level evidence, and hydration is used less often than other clinical settings.To perform a systematic review and meta-analysis of all randomized controlled trials assessing intravenous hydration compared with non-hydration for prevention of contrast induced nephropathy (CIN) and In-hospital mortality in patients with STEMI undergoing primary PCI. Methods: Medline, EMBASE and the Cochrane Register were searched to September 2018. Included studies reported the incidence of CIN, In-hospital mortality, requirement for dialysis and heart failure. Relative risks with 95% confidence intervals (CIs) for individual trials were pooled using a random effects model. Results: Three moderate quality trials were identified including 1074 patients. Overall, compared with no hydration, intravenous hydration significantly reduced the incidence of CIN by 42% (RR 0.58; 95% CI: 0.45 to 0.74, p < 0.001). The estimated effects upon all-cause mortality (RR 0.56; 95% CI: 0.30 to 1.02, p = 0.057) and the requirement for dialysis (RR 0.52, 95% CI 0.14-1.88, p = 0.462) were not statistically significant. The outcome of heart failure was not consistently reported. Conclusions: Intravenous hydration likely reduces the incidence of CIN in patients with STEMI undergoing primary PCI. However, for key clinical outcomes such as mortality, heart failure and dialysis the effect estimates were imprecise. Further high quality studies are needed to clarify the appropriate volume of fluid and effects on outcomes.

Original languageEnglish
Article number87
Pages (from-to)1-9
Number of pages9
JournalBMC Cardiovascular Disorders
Volume19
Issue number1
DOIs
Publication statusPublished - 8 Apr 2019
Externally publishedYes

Bibliographical note

Copyright the Author(s) 2019. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.

Keywords

  • Contrast-induced nephropathy
  • Intravenous hydration
  • Primary percutaneous coronary intervention, acute kidney injury, dialysis, mortality
  • ST-segment elevation-myocardial infarction
  • acute kidney injury
  • dialysis
  • mortality

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