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Abstract: TH-OR01

The Relationship Between Intravenous Fluid Administration and Renal Outcomes After Angiography

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Soomro, Qandeel H., New York University, New York, New York, United States
  • Anand, Sonia T., VA Boston Health Care System Massachusetts Veterans Epidemiology Research and Information Center, Jamaica Plain, Massachusetts, United States
  • Weisbord, Steven D., University of Pittsburgh, Pittsburgh, Pennsylvania, United States
  • Gallagher, Martin P., The George Institute for Global Health, Newtown, New South Wales, Australia
  • Ferguson, Ryan E., Veterans Affairs Boston Healthcare System, Boston, Massachusetts, United States
  • Palevsky, Paul M., VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, United States
  • Kaufman, James S., Veterans Affairs Boston Healthcare System, Boston, Massachusetts, United States
Background

Contrast associated AKI (CA-AKI) may result in prolonged hospital stay and increased mortality. Fluids remain the mainstay for prevention. There is a lack of consensus on the optimal fluid rate and amount. Using the PRESERVE dataset, we studied the effect of peri-procedure fluid administration strategies on CA-AKI and 90-day need for dialysis, death, or a 50% increase in serum creatinine

Methods

We conducted a secondary analysis of 4993 of PRESERVE participants who received either IV saline or IV bicarbonate prophylaxis. Although fluid type was randomized, strategy of administration was at the discretion of the clinician. We divided the study group into quartiles by total fluid volume. Multivariable analysis was performed using logistic regression adjusting for age, history of heart failure, diabetes mellitus, left ventricular end-diastolic pressure, baseline glomerular filtration rate, procedure type, inpatient vs. outpatient status, and duration. We also tested for the interaction between fluid volume and duration of fluid administration categorized as <6 or ≥6 hours

Results

Compared to the highest quartile (Q4) of fluid volume, there was a significantly increased risk of the primary 90 day end point in quartile 1. There were no differences between quartiles 2 and 3 compared to quartile 4. There was no significant difference in the incidence of CA-AKI across the groups. The interaction between volume and duration of fluid administration was not significant

Conclusion

We found that fluid volumes <964 ml may be associated with an increased risk for the primary outcome although residual confounding cannot be excluded; and that administering higher volumes over a total duration of <6 hours seem to be equally protective. The utility of high volume, short duration fluid administration protocols will facilitate the safe performance of out-patient procedures.