Intraprocedural continuous saline infusion lines significantly reduce the incidence of acute kidney injury during endovascular procedures for stroke and myocardial infarction: evidence from a systematic review and meta-regression
Authors: De Rubeis Gianluca , Zilahi De Gyurgyokai Simone , Fabiano Sebastiano , Bertaccini Luca , Wlderk Andrea , Pezzella Francesca Romana , Anticoli Sabrina , Biondi Zoccai Giuseppe , Versaci Francesco , Saba Luca , Pampana Enrico 
Published: October 2023

Background

Contrast media used in mechanical therapies for stroke and myocardial infarction represent a significant cause of acute kidney injury (AKI) in acute medical scenarios. Although the continuous saline infusion line (CSIL) is a standard procedure to prevent thrombus formation within the catheter during neurovascular interventions of mechanical thrombectomy (MT), it is not utilized in percutaneous coronary interventions (PCI).

Material and methods

A systematic review of the incidence of AKI after MT for stroke treatment was performed. These data were compared with those reported in the literature regarding the incidence of AKI after PCI for acute myocardial infarction. A random-effect model meta-regression was performed to explore the effects of CSIL on AKI incidence, using clinical details as covariates.

Results

A total of 18 and 33 studies on MT and PCI were included, respectively, with 69,464 patients (30,138 [43.4%] for MT and 39,326 [56.6%] for PCI). The mean age was 63.6 years ±5.8 with male 66.6% ±12.8. Chronic kidney disease ranged 2.0%–50.3%. Diabetes prevalence spanned 11.1% to 53.0%. Smoking status had a prevalence of 7.5%–72.0%. Incidence of AKI proved highly variable (I2=98%, Cochrane’s Q 2985), and appeared significantly lower in the MT subgroup than in the PCI subgroups (respectively 8.3% [95% confidence interval: 4.7%–11.9%] vs 14.7 [12.6%– 16.8%], p<0.05). Meta-regression showed that CSIL was significantly associated with a decreased incidence of AKI (OR=0.93 [1.001–1.16]; p=0.03).

Conclusion

Implementation of CSIL during endovascular procedures in acute settings was associated with a significant decrease in the risk of AKI, and its safety should be routinely considered in such interventions.

Condensate abstract

Acute kidney injury (AKI) has an incidence rate of 21.6% in the acute setting. The occurrence of AKI during acute myocardial infarction (AMI) increases the chance of death with an OR of 12.52 (95% CI 9.29–16.86). This study explored the effect of continuous saline infusion line (CSIL) on the incidence of AKI by comparing mechanical thrombectomy and percutaneous coronary intervention. Meta-regression showed that CSIL was significantly associated with a decreased incidence of AKI (OR=0.93 [1.001–1.16]; p=0.03). By implementing CSIL as a standard operative procedure in PCI, 1 out of 9 deaths could be prevented during AMI treated with PCI.

What is Known

Contrast media induces acute kidney injury.

Acute kidney injury increases mortality in ischemic stroke and acute myocardial infarction

Saline infusion has been used to prevent and treat acute kidney injury.

Continue saline infusion is used in neurovascular intervention for preventing thrombus formation

What the Study Adds

Continue saline infusion during percutaneous arterial treatment reduces the incidence of acute kidney injury

Conflict of Interest statement

GBZ: Amarin, Balmed, Cardionovum, Crannmedical, Endocore Lab, Eukon, Guidotti, Innovheart, Meditrial, Microport, Opsens Medical, Terumo, and Translumina, outside the present work. The remaining authors have no COI

The manuscript complies with all instructions to authors

The authorship requirements have been met and the final draft was approved by all authors

A list of each author’s contributions

Conceptualization GDR and SZG; methodology GDR and LS, software GDR; validation formal analysis GDR, SA, EP, SF, GBZ, FRP, FV; investigation GDR And MA; resources LB and AW; data curation GDR and SZG; writing—original draft preparation GDR; writing—review and editing LS, EP, SF, SA, FRP, GBZ, FV; visualization GDR; supervision LS, EP, SF, SA, FRP, GBZ, FV;

The manuscript has not been published elsewhere and is not under consideration by another journal

The paper adherences to ethical guidelines and indicate ethical approvals (IRB) and use of informed consent, as appropriate. IRB approvals was not necessary being the paper a systematic review and meta-analysis

Reporting checklist

PRISMA

TOC category

Coronary intervention

Classification

Clinical