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

Abstract

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.

Global Perspectives in Acute Kidney Injury: Spain

“…17 For that reason, the administration of n-acetylcysteine has been individualized and not standardized in our country, and hydration is considered as the only preventive measure. 18 RRT in AKI: Management, RRT Used, Availability, and Costs…”

A Hidratação Oral pode ser uma Opção na Prevenção da Nefropatia Induzida por Contraste em Intervenções Coronárias Eletivas

“… 2 , 3 Dentre as diversas drogas, o nicorandil tem sido utilizado em pacientes com disfunção renal crônica. 4 , 5 …”

“… 2 , 3 Among different drugs, nicorandil has been used in patients with chronic renal dysfunction. 4 , 5 …”