SP 2.02 Impact of a Peri-Procedural Hydration Protocol on Acute Kidney Injury (AKI) Following Pharmacomechanical Thrombectomy (PMT) and/or Catheter-Directed Thrombolysis (CDT) for Deep Vein Thrombosis (DVT)
Avilash Mishra, Rianne Agboola, Aleena Biju, Belen Quintana, Taha KhanAbstract
Aim
PMT and/or CDT for DVT carry risks AKI, primarily due to iodinated contrast exposure and hemolysis. The KDIGO Clinical Practice Guideline for AKI (2012) recommends peri-procedural risk assessment, avoidance of nephrotoxins, and volume expansion with isotonic fluids. Similarly, the Renal Association, British Cardiovascular Intervention Society (BCIS), and Royal College of Radiologists (RCR) joint consensus (2021) advocates pre- and post-procedural hydration with isotonic saline. Published data suggest AKI rates after PMT/CDT range from 20–30%, depending on technique and contrast load. This study aimed to evaluate the effect of introducing a peri-procedural hydration protocol on AKI incidence in patients undergoing PMT/CDT for DVT.
Methods
A two-cycle audit was conducted for patients undergoing a procedure between 2021 and 2025. Cycle 1 (42 patients) included cases before protocol implementation, and Cycle 2 (65 patients) involved cases after protocol introduction. The primary outcome was the incidence of AKI within 48 hours post-procedure, defined by KDIGO criteria.
Results
In Cycle 1, 26% (11/42) of patients developed AKI. Following the hydration protocol's introduction in Cycle 2, AKI incidence dropped to 6.2% (4/65). This reduction was statistically significant (p = 0.011), representing an 80% relative risk reduction in AKI.
Conclusion
Introduction of a peri-procedural hydration protocol significantly reduced the incidence of AKI in patients undergoing PMT/CDT for DVT. These findings support the standardization of hydration protocols for all PMT/CDT procedures. Further monitoring and re-audit are recommended after 12 months to ensure sustained benefit.