Abstract: FR-PO059
Short-Term Dietary Restriction for Prevention of Contrast-Induced AKI in Patients at Risk Undergoing Percutaneous Coronary Angiography: A Randomized Controlled Pilot Trial
Session Information
- AKI: Clinical Outcomes, Trials
November 08, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Grundmann, Franziska, University of Cologne, Cologne, Germany
- Mueller, Roman-Ulrich, University of Cologne, Cologne, Germany
- Späth, Martin R., University of Cologne, Cologne, Germany
- Benzing, Thomas, University of Cologne, Cologne, Germany
- Burst, Volker Rolf, University of Cologne, Cologne, Germany
Background
Short-term dietary restriction (DR) has been proven effective to prevent acute organ damage from ischemic or toxic insults in animal models but clear evidence for effectiveness in humans is missing. Contrast media-induced acute kidney injury (CI-AKI) represents a leading cause of hospital-acquired acute kidney injury and both, ischemia and cytotoxic effects contribute to its pathophysiology. The objective of this trial was to determine the effectiveness of a 4-day dietary restriction for the prevention of CI-AKI in patients undergoing percutaneous coronary intervention (PCI).
Methods
Patients scheduled for PCI were randomized to receive either a formula diet containing 60% of calculated daily energy requirement (DR group, n=40) or ad-libitum food (control group, n=40) in the 4-day interval before PCI. Primary endpoint was the change of serum creatinine 48h after PCI (Δcreatinine). Further exploratory analyses included various renal function parameters, incidence of CI-AKI, and safety evaluation.
Results
With a median Δcreatinine post PCI of 0.03 (-0.15,0.14) mg/dL in the DR group vs. 0.09 (-0.03,0.22) mg/dL in the control group there was no difference in the primary endpoint (p=0.797). Subgroup analyses revealed a significant beneficial impact of DR in patients that received ≤100ml of contrast agent (DR n=26: Δcreatinine -0.03 (-0.20,0.08) mg/dL vs. control n=24: Δcreatinine 0.10 (-0.08,0.24) mg/dL; p=0.041) and in patients with ≤2 risk factors for CI-AKI (DR: n=27; Δcreatinine -0.01(-0.18,0.07) mg/dL vs. control n=31: Δcreatinine 0.09 (-0.03,0.16) mg/dl; p=0.030). Most patients in the experimental group reported a good physical condition (59.4%) with respect to DR and only 5.6% reported a profound sensation of hunger.
Conclusion
Although the primary endpoint was not met, the results of this trial suggest a beneficial impact of DR in low-to-moderate risk patients. Moreover, in this setting DR appears safe and feasible. Further investigations are needed in order to optimize DR protocols and to exploit its therapeutic potential.
Funding
- Government Support - Non-U.S.