AKIGUARD (Acute Kidney Injury GUARding Device) trial: in-hospital and one-year outcomes

AimsContrast-induced acute kidney injury (CIAKI) in patients with chronic kidney disease undergoing coronary angiography or percutaneous coronary intervention is a common iatrogenic complication associated with increased morbidity and mortality. This study compares sodium bicarbonate/isotonic saline/N-acetylcysteine/vitamin C prophylaxis (BS-NAC) against high-volume forced diuresis with matched hydration in CIAKI prevention.MethodsOne-hundred and thirty-three consecutive patients undergoing coronary angiography or percutaneous coronary intervention with estimated glomerular filtration rate less than 60mL/min/1.73m(2) were randomized to the study group receiving matched hydration (MHG) or to the control group receiving BS-NAC. MHG received in vein (i.v.) 250mL isotonic saline bolus, followed by a 0.5mg/kg furosemide i.v. bolus to forced diuresis. A dedicated device automatically matched the isotonic saline i.v. infusion rate to the urinary output for 1h before, during and 4h after the procedure.ResultsMHG had the lowest incidence of CIAKI (7 vs. 25%, P=0.01), major adverse cardiac and cerebrovascular events at 1 year (7 vs. 32%, P<0.01) and readmissions to cardiology/nephrology departments (8 vs. 25%, P=0.03; hospitalization days 1.03.8 vs. 4.9 +/- 12.5, P=0.01). Three months after the procedure the decrease in the estimated glomerular filtration rate was 0.02% for MHG versus 15% for the control group.ConclusionMatched hydration was more effective than BS-NAC in CIAKI prevention. One-year follow-up showed that matched hydration was associated also with limited chronic kidney disease progression, major adverse cardiac and cerebrovascular events and hospitalizations.