Haemodynamic-guided fluid administration for the prevention of contrast-induced acute kidney injury: the POSEIDON randomised controlled trial

摘要: Summary Background The administration of intravenous fluid remains the cornerstone treatment for prevention contrast-induced acute kidney injury. However, no well-defined protocols exist to guide in this treatment. We aimed establish efficacy a new protocol prevent Methods In randomised, parallel-group, comparator-controlled, single-blind phase 3 trial, we assessed based on left ventricular end-diastolic pressure injury patients undergoing cardiac catheterisation. primary outcome was occurrence injury, which defined as greater than 25% or 0·5 mg/dL increase serum creatinine concentration. Between Oct 10, 2010, and July 17, 2012, 396 aged 18 years older catheterisation with an estimated glomerular filtration rate 60 mL/min per 1·73 m 2 less one more several risk factors (diabetes mellitus, history congestive heart failure, hypertension, age 75 years) were randomly allocated 1:1 ratio pressure-guided volume expansion (n=196) control group (n=200) who received standard protocol. Four computer-generated concealed randomisation schedules, each permuted block sizes 4, used randomisation, participants next sequential number by sealed opaque envelopes. Patients laboratory personnel masked assignment, but physicians did procedures not masked. Both groups 0·9% sodium chloride at mL/kg 1 h before Analyses intention treat. Adverse events 30 days 6 months all such classified staff assignment. This trial is registered ClinicalTrials.gov, NCT01218828. Findings Contrast-induced occurred frequently (6·7% [12/178]) (16·3% [28/172]; relative 0·41, 95% CI 0·22–0·79; p=0·005). Hydration terminated prematurely because shortness breath three group. Interpretation Left seems be safe effective preventing Funding Kaiser Permanente Southern California regional research committee grant.