BACKGROUND: Contrast-induced acute kidney injury (CI-AKI) is a frequent complication of coronary interventions associated with an increased risk of mortality and morbidity. The optimal intravenous hydration strategy to prevent CI-AKI is not well-established. The primary objective is to determine if a tailored hydration strategy reduces the risk of CI-AKI and of major adverse cardiovascular events (MACE) in patients undergoing coronary angiography compared with a nontailored hydration strategy. METHODS: A study-level meta-analysis of randomized controlled trials comparing tailored versus nontailored hydration strategies for the prevention of CI-AKI (primary outcome) and of MACE (main secondary outcome) in patients undergoing coronary angiography for any indication was performed. Tailored hydration was defined as the administration of intravenous fluids based on patient-specific parameters other than weight only. RESULTS: A total of 13 studies were included (n = 4,458 participants). The overall risk of bias was moderate. A tailored strategy was associated with a significant reduction in the risk of CI-AKI (RR = 0.56, 95% CI, [0.46-0.69], P <
.00001
I CONCLUSION: These results suggest that tailored hydration is superior to nontailored hydration in reducing the risk of CI-AKI and MACE in patients undergoing coronary angiography. Future trials are required to identify the optimal tailored hydration strategy.