Effectiveness of oral hydration in preventing contrast-induced acute kidney injury in patients undergoing coronary angiography or intervention

Zhang, Weidai; Zhang, Jiawei; Yang, Banghua; Wu, Kefei; Lin, Hao; Wang, Yanping; Zhou, Lihong; Wang, Huatao; Zeng, Chujuan; Chen, Xiao; Wang, Zhixing; Zhu, Jihong; Chen, Songming

doi:10.1097/mca.0000000000000607

Cited by 33 publications

(25 citation statements)

References 29 publications

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“…The latest three studies reported similar results [24–26]. Four meta-analyses have been published so far, which included between four and eight randomized controlled trials (RCTs) [13, 27–29]. These studies also demonstrated no significant difference between oral fluid hydration and intravenous fluid hydration regimens in the prevention of CI-AKI, nor that the oral route was inferior.…”

Section: Discussionmentioning

confidence: 84%

Efficacy of post-procedural oral hydration volume on risk of contrast-induced acute kidney injury following primary percutaneous coronary intervention: study protocol for a randomized controlled trial

Song

Sun

Liu

et al. 2019

Trials

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Background Contrast-induced acute kidney injury (CI-AKI) contributes toward unfavorable clinical outcomes. Oral hydration with water is inexpensive and it may be effective in the prevention of CI-AKI, but its efficacy among patients undergoing primary percutaneous coronary intervention (PCI) remains unknown. Methods/design Our study is a secondary analysis on the database from the ATTEMPT study. We enrolled ST-elevation myocardial infarction (STEMI) patients undergoing primary PCI. Eligible patients received peri-procedural aggressive (left ventricular end-diastolic pressure-guided) or routine (≤ 500 mL) intravenous hydration with an isotonic solution (0.9% NaCl) with randomization. The primary endpoint was CI-AKI, defined as a > 25% or 0.5 mg/dL increase in serum creatinine from baseline during the first 48–72 h post-procedurally. All patients drank unrestricted amounts of fluids freely, the volume of which was recorded until 24 h following primary PCI. Oral hydration volume/weight (OHV/W) ratios were calculated. The association between post-procedural oral hydration (quartiles) and CI-AKI was assessed using multivariable analysis controlling for confounders, including intravenous hydration strategies. Discussion Our study determined the effects of post-procedural oral hydration on CI-AKI following primary PCI, which is a potential strategy for CI-AKI prevention among patients with STEMI at very high risk. Trial registration ClinicalTrials.gov, NCT02067195 . Registered on 21 February 2014. Electronic supplementary material The online version of this article (10.1186/s13063-019-3413-5) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 84%

Efficacy of post-procedural oral hydration volume on risk of contrast-induced acute kidney injury following primary percutaneous coronary intervention: study protocol for a randomized controlled trial

Song

Sun

Liu

et al. 2019

Trials

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“…saline or bicarbonate, is currently the cornerstone of PC-AKI prophylaxis [11]. However, oral hydration may also be an option in the prophylaxis of PC-AKI, as we stated in the results of our NICIR trial, published recently in this journal, and in a recently published meta-analysis [12] [13].…”

Section: Introductionmentioning

confidence: 88%

Oral hydration as a safe prophylactic measure to prevent post-contrast acute kidney injury in oncologic patients with chronic kidney disease (IIIb) referred for contrast-enhanced computed tomography: subanalysis of the oncological group of the NICIR study

Sebastiá

Páez-Carpio

Guillén

et al. 2021

Support Care Cancer

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BackgroundThe objective of this study is to evaluate oral hydration compared to intravenous (i.v.) hydration in the prevention of post-contrast acute kidney injury (PC-AKI) in the oncologic subgroup of patients with stage IIIb chronic kidney disease (CKD) included in the NICIR study referred for elective contrast-enhanced computed tomography (CE-CT). Material and MethodsWe performed a retrospective subanalysis of the oncological subgroup (174/228 patients, 74%) from a continuous prospective database of patients included in the recently published non-inferiority NICIR study. Patients received prophylaxis against PC-AKI with either oral hydration (500 mL of water two hours before and 2000 mL during the 24 hours after CE-CT) or i.v. hydration (sodium bicarbonate (166 mmol/L)3 mL/kg/h starting one hour before and 1 mL/kg/h during the rst hour after CE-CT). The primary outcome was to compare the proportion of PC-AKI in the rst 48 to 72 hours after CE-CT in the two hydration groups. Secondary outcomes were to compare persistent PC-AKI, the need for hemodialysis, and the occurrence of adverse events related to prophylaxis in each group. ResultsOf 174 patients included in the subanalysis, 82 received oral hydration and 92 received i.v. hydration. There were no signi cant differences in clinical characteristics or risk factors between the two study arms. Overall the PC-AKI rate was 4.6% (8/174 patients), being 3.7% in the oral hydration arm (3/82 patients) and 5.4% (5/92 patients) in the i.v. hydration arm. The persistent PC-AKI rate was 1.8% (1/82 patients) in the oral hydration arm and 3.3% (3/92 patients) in the i.v. hydration arm. No patient required dialysis during the rst month after CE-CT or had adverse effects related to the hydration regime. ConclusionIn oncological patients with stage IIIb CKD referred for elective CE-CT, the rate of PC-AKI in those receiving oral hydration did not signi cantly differ from that of patients receiving i.v. hydration.

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“…There is no clear evidence on the best route of hydration, enteral or parenteral, to prevent CI-AKI. A meta-analysis of 8 studies with 1754 participants showed noninferiority of oral hydration compared to IV for the prevention of CI-AKI in coronary angiography [32]. Mueller et al conducted a study with 1620 patients undergoing coronary angiography and concluded that for CI-AKI prophylaxis hydration with isotonic saline 0.9% (809 patients, incidence of CI-AKI 0.7%) was more beneficial than half-isotonic saline 0.45% (811 patients, incidence of CI-AKI 2%), especially in women, diabetics and patients receiving equal or greater than 250 mL of CM [33].…”

Section: Pharmacological Strategiesmentioning

confidence: 99%

Contemporary Modalities in the Prevention of Contrast-Induced Acute Kidney Injury

Theofilis¹,

Vordoni

2021

BJSTR

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Contrast-induced acute kidney injury (CI-AKI) is the third leading cause of acute kidney injury deriving from the intravascular administration of contrast media in diagnostic and therapeutic procedures and leading to longer in-hospital stay and increased short and long-term mortality. Its pathophysiology, although not well-established, revolves around medullary hypoxia paired with the direct toxicity of the substance to the kidney. Critically ill patients, as well as those with pre-existing renal disease and cardiovascular comorbidities, are more susceptible to CI-AKI. Despite the continuous research on the field of CI-AKI prevention, clinical practice is based mostly on periprocedural hydration. In this review, all the investigated methods of prevention are being presented, with the potency of RenalGuard and contrast-removal systems being stressed as the method of choice for CI-AKI prevention in high-risk individuals.

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Effectiveness of oral hydration in preventing contrast-induced acute kidney injury in patients undergoing coronary angiography or intervention

Abstract: Our study shows that oral hydration is not inferior to intravenous hydration for the prevention of CI-AKI in patients with normal or mild-to-moderate renal dysfunction undergoing coronary angiography or intervention.

Cited by 33 publications

References 29 publications

Efficacy of post-procedural oral hydration volume on risk of contrast-induced acute kidney injury following primary percutaneous coronary intervention: study protocol for a randomized controlled trial

Efficacy of post-procedural oral hydration volume on risk of contrast-induced acute kidney injury following primary percutaneous coronary intervention: study protocol for a randomized controlled trial

Oral hydration as a safe prophylactic measure to prevent post-contrast acute kidney injury in oncologic patients with chronic kidney disease (IIIb) referred for contrast-enhanced computed tomography: subanalysis of the oncological group of the NICIR study

Contemporary Modalities in the Prevention of Contrast-Induced Acute Kidney Injury

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