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Background: There are several reports suggesting that admission hyperglycaemia increases the risk of contrast-induced acute kidney injury (CI-AKI). However, it is not clear whether there has been an association between long-standing poor glycaemic control and the incidence of CI-AKI. The purpose of this study was to examine the impact of poor glycaemic control or elevated glycosylated haemoglobin (HbA1c) on the incidence of CI-AKI in patients with type 2 diabetes mellitus (T2DM)., Methods: The present study prospectively enrolled 133 patients with T2DM undergoing elective coronary angiography (CAG) and/or intervention. All patients had an estimated glomerular filtration rate (eGFR) of ≥60 ml/min/1.73 m(2). Patients were divided into two groups: those with an optimal HbA1c (<7%) and those with an elevated HbA1c (≥7%). All had similar baseline characteristics and were hydrated appropriately. The outcome was assessed by the incidence of CI-AKI., Results: CI-AKI occurred in 2 of 41 patients (4.9%) with optimal HbA1c levels and 5 of 92 patients (5.4%) with elevated HbA1c levels (p = 0.89). The cutoff point of HbA1c was set at 6.5%, but no statistically significant difference between the two groups was observed [1 of 24 patients (4.1%) vs. 6 of 109 patients (5.5%), p = 0.79]. However, despite a high variability in the incidence of CI-AKI, there was no statistically significant difference between the two groups when varying CI-AKI definitions were considered., Conclusion: An elevated HbA1c level is not associated with a higher incidence of CI-AKI compared to optimal HbA1c levels in patients with T2DM (patients with an eGFR of ≥60 ml/min/1.73 m(2)) undergoing CAG and/or intervention.

Background: Efficacy of intravenous (IV) volume expansion in preventing contrast-induced acute kidney injury (CI-AKI) is well known. However, the role of oral hydration has not been well established. The aim of this work was to evaluate the efficacy of oral hydration in preventing CI-AKI., Methods: We prospectively randomized 225 patients undergoing coronary angiography and/or percutaneous coronary intervention in either oral hydration or IV hydration groups. Patients who have at least one of the high-risk factors for developing CI-AKI (advanced age, type 2 diabetes mellitus, anemia, hyperuricemia, a history of cardiac failure or systolic dysfunction) were included in the study. All patients had normal renal function or stage 1-2 chronic kidney disease. Patients in the oral hydration group were encouraged to drink unrestricted amounts of fluids freely whereas isotonic saline infusion was performed by the standard protocol in the IV hydration group., Results: CI-AKI occurred in 8/116 patients (6.9%) in the oral hydration group and 8/109 patients (7.3%) in the IV hydration group (p = 0.89). There was also no statistically significant difference between the two groups when different CI-AKI definitions were taken into account., Conclusion: Oral hydration is as effective as IV hydration in preventing CI-AKI in patients with normal kidney function or stage 1-2 chronic kidney disease, and who also have at least one of the other high-risk factors for developing CI-AKI., (© 2014 S. Karger AG, Basel.)