A Randomized Prospective Trial to Assess the Role of Saline Hydration on the Development of Contrast Nephrotoxicity

Abstract

Though simple and attractive, the role of hydration for the prophylaxis of contrast nephrotoxicity has not been definitively established. We prospectively evaluated the role of deliberate saline hydration in patients undergoing nonemergency cardiac catheterization. Patients (n = 53) were randomized on the day prior to scheduled catheterization to one of two groups – group 1 (n = 27) received normal saline for 24 h (at a rate of 1 ml/kg/h) beginning 12 h prior to scheduled catheterization, and group 2 (n = 26) were allowed unrestricted oral fluids. Serum creatinine measured 24 and 48 h postcardiac catheterization was compared to the pre-randomization baseline value. The mean baseline calculated creatinine clearance was 79.6 ± 31.9 ml/min and the mean baseline creatinine was 106 ± 28 µmol/l. An increase in serum creatinine by at least 44.2 µmol/l (0.5 mg/dl), within 48 h of contrast exposure, was considered to represent clinically significant acute renal insufficiency. Ten subjects (18.9%) developed acute renal insufficiency. The incidence of acute renal insufficiency was significantly lower in group 1 (1 out of 27) as compared to group 2 (9 out of 26; p = 0.005 for comparison between groups; relative risk 0.11, 95% confidence interval 0.015 to 0.79). Twenty-four hours after contrast exposure, the mean increase in creatinine was less in group 1 vs. group 2 (8 ± 11 vs. 20 ± 21 µmol/l, p = 0.02). The increase in creatinine was not significantly different in group 1 vs. group 2 48 h after contrast exposure (12 ± 21 vs. 29 ± 40 µmol/l, p = 0.17). Deliberate saline hydration decreases the incidence of contrast-related acute renal failure and the severity of contrast-induced renal dysfunction in patients undergoing non-emergency cardiac catheterization.

Contrast‐induced nephropathy

“…In the randomized PRINCE trial [50], the achievement of high urine flow rate by forced diuresis with intravenous 0.45% saline, mannitol, and furosemide provided, compared with control (0.45% saline plus placebo), only modest benefit in prevention of CIN. Two randomized studies compared different modes of fluids administration: intravenous versus oral [51,52]. While the first study of 36 patients comparing 0.45% saline solution intravenously for 24 hr with 1,000 mL liquid orally preprocedure followed by 6-hr saline infusion did not demonstrate a difference between two arms (CIN 11.1% vs. 5.6%, respectively; P ¼ NS) [51], the study by Trivedi (53 patients) favored intravenous administration of fluids (CIN 3.7% vs. 34.6%, respectively; P ¼ 0.005) [52].…”

“…Two randomized studies compared different modes of fluids administration: intravenous versus oral [51,52]. While the first study of 36 patients comparing 0.45% saline solution intravenously for 24 hr with 1,000 mL liquid orally preprocedure followed by 6-hr saline infusion did not demonstrate a difference between two arms (CIN 11.1% vs. 5.6%, respectively; P ¼ NS) [51], the study by Trivedi (53 patients) favored intravenous administration of fluids (CIN 3.7% vs. 34.6%, respectively; P ¼ 0.005) [52]. Two small studies compared overnight and short bolus infusion prior to catheterization.…”

Implications of Renal Complications In Out Patient Referral for Coronary Angiography: Prospective Observational Study of 98 Cases

“…For patients receiving an iodinated contrast agent in an outpatient setting, oral hydration is an alternative to avoid hospitalization; however, it should be associated with increased sodium intake [11].…”

Prevenção de nefrotoxicidade por contraste com solução de bicarbonato: resultados preliminares e revisão da literatura

“…In fact, hydration protects against CN, while the use of diuretics increases the frequency of CN. [22][23] Alterations that cause a reduction in the effective circulating volume, such as cardiogenic shock, use of intra-aortic balloon, hypotension, congestive heart failure, and ejection fraction below 40%, have been listed as possible risk factors for CN. 24 Older studies also considered the female sex as a risk factor for CN.…”