LAUSR

Objective: Contrast-induced acute kidney injury (CI-AKI) is a serious complication of the administration of iodinated contrast media (CM) for interventional cardiovascular procedures and is associated with substantial morbidity and mortality. We performed a single-centre prospective study to determine the effect of implementation of algorithm preventing on the incidence of CI-AKI in patients with unstable angina pectoris/non-ST-segment elevation myocardial infarction (UAP/NSTEMI) and delayed percutaneous coronary intervention (PCI). Design and method: We used of historical control data for assessing of algorithm preventing CI-AKI in routine clinical practice. The study compared two groups of patients with UAP/NSTEMI and delayed PCI before and after implementation of algorithm preventing CI-AKI. In 1 Group - control group (n = 86) we used the routine prophylaxis CI-AKI: in patients with eGFR <60 ml/min/1,73 m2 received intravenous hydration of 0.9% saline solution of sodium chloride (NaCl) at a rate of 1.0–1.5 ml/kg /h before the PCI. In 2 group - prevent group (n = 86) we prevented CI-AKI according to the algorithm: patients with eGFR <60 ml/min/1,73 m2 and/or with Mehran risk score >10 received intravenous fluid administration hydration of 0.9% NaCl and N-Acetylcysteine (NAC): without heart failure -0.9% NaCl 1 ml/kg/h for 12 hours pre-procedure and 12 hours post-procedure contrast administration; with heart failure - 0.9% NaCl 0,5 ml/kg/h for 12 hours pre-procedure and 12 hours post-procedure contrast administration; with NAC 600 mg before PCI and 600 mg after PCI. Both groups were comparable in age (60 ± 12 and 61 ± 11 years), comorbidity (hypertension 96 and 97%, chronic kidney disease 31 and 29%, diabetes mellitus 34 and 28%) and received therapy. CI-AKI was defined using 2012 KDIGO Guidelines. Isoosmolar contrast media iodixanol (Visipaque-320) or low-osmolar contrast media iohexol (Omnipaque-350) were used. Transradial access for PCI was used in 98% of patients. Mann-Whitney test and multivariate logistic regression analysis were performed. P < 0.05 was considered statistically significant. Results: The incidence of CI-AKI in intervention group was significantly lower than in the control group (6 vs 13%, p < 0.05). Conclusions: Implementation of algorithm preventing in clinical practice significantly reduced risk of contrast-induced acute kidney injury in patient with delayed percutaneous coronary intervention.