Role of hydration in contrast-induced nephropathy: a review

Ajwah, Ibrahim; Alotaibi, Mohammed; Alanazi, Reema Abdulrahman A.; Altemani, Rayyan Fahad H.; Aljadrawi, Wafaa Faisal; albalawi, Thekra Zaidan Ali; Althobeiti, ALanoud Abdullah Hamed; Alatawi, Atheer Mansour E; Albalawi, Aseel Ali T.; Albalawi, Nashwa Zead A.; Albalawi, Maryam Awad H.; Bedaiwi, Lama Abdulrahman A.; Albalawi, Zainab Atallah S.; Alharthi, Yousef; Alamri, Mohammed Abdulwahed H.; Alnasser, Ali Khalid Ali

doi:10.24911/ijmdc.51-1602705304

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“…Hydration also increases the urinary flow rate, which reduces the concentration and the transit time of contrast in the renal tubules, thus reducing the risk of direct exposure between the renal tubules and contrast media [ 25 ]. For the prevention of CI-AKI in patients with kidney disease, it is recommended to give hydration with a normal saline infusion at the rate of 1 ml/kg/hour over 6-12 hours pre-procedure and it should be continued for 24 hours after the procedure [ 26 , 27 ]. Some randomized control trials and meta-analyses compared the effectiveness between intravenous fluid and oral fluid, and studies revealed that oral hydration is as effective as IV saline [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

“…For the prevention of CI-AKI in patients with kidney disease, it is recommended to give hydration with a normal saline infusion at the rate of 1 ml/kg/hour over 6-12 hours pre-procedure and it should be continued for 24 hours after the procedure [ 26 , 27 ]. Some randomized control trials and meta-analyses compared the effectiveness between intravenous fluid and oral fluid, and studies revealed that oral hydration is as effective as IV saline [ 26 ]. Hydration should be done carefully in patients with severe renal insufficiency and cardiac failure due to the risk of volume overload [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

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Is It Safe to Do Percutaneous Coronary Intervention in Moderate to Severe Chronic Kidney Disease Patients? A Prospective Cohort Study

Santosa¹,

Harca²,

Yuwono³

et al. 2022

Cureus

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Introduction: Contrast-induced acute kidney injury (CI-AKI) is a common and potentially serious complication of percutaneous coronary intervention (PCI) procedures, as it induces acute kidney injury (AKI), especially in previously diagnosed chronic kidney disease (CKD) patients, particularly in those who also have diabetes. Adequate hydration and using a minimal volume of contrast media are the recommended measures to decrease CI-AKI in CKD patients. A combination of sodium bicarbonate and N-acetylcysteine (NAC) may be a superior strategy for preventing CI-AKI. This study is aimed to evaluate the safety of PCI in moderate to severe CKD patients.Method: This was a prospective, single-center study, from 2019 to 2021. We included all chronic kidney disease who undergo PCI procedures. The kidney level was measured on admission and 24 hours after the PCI procedure. The patients received 75 meq/500 mL of sodium bicarbonate one to six hours before procedures, oral acetylcysteine 600 mg bid for three days, and rehydration with 1000 ml of normal saline infusion for eight hours in patients without congestive heart failure. SPSS Version 23.0 (IBM SPSS Statistics for Windows, Version 23.0., IBM Corp., Armonk, NY) was used to input and process the data.Results: This study included 118 subjects, with baseline characteristics of age 58.77 ± 9.08 years, 80.5% male, 47.5% diabetic, 50% hypertension, and 59.5% congestive heart failure. From the coronary angiogram, we found most of our subjects (57.6%) had three-vessel disease, 28.8% had two-vessel disease, and 15.6% had one-vessel disease. About 67.8% of subjects used <50 ml of low molecular contrast. The baseline creatinine level was 2.46 ± 1.04 mg/dL and the estimated glomerular filtration rate (eGFR) was 30 ± 12.65 mL/min. There were 19 (16.1%) patients with stage 3A CKD, 45 (38.1%) stage 3B, 41 (34.7%) stage 4, and 41 (34.7%) stage 5. The kidney function test after 24 hours of contrast admission showed a creatinine level of 2.37 ± 1.20 mg/dL (P<0.05) and the eGFR of 34.74 ± 16.10 mL/min. There was no significant difference in creatinine levels between stage 3A and stage 5 CKD. There was a significant reduction in creatinine in stage 3B CKD, from 1.917 ± 0.22 to 1.71 ± 0.37 mg/dL (P = 0.001); and stage 4 CKD, from 2.77 ± 0.55 to 2.72 ± 0.94 mg/dL (P = 0.013).Discussion: CKD is a risk factor for developing CI-AKI after PCI, which is a marker of poor long-term outcomes. The development of CI-AKI is a strong predictor of post-PCI bleeding, which aggravates hemodynamic instability. The combination of NAC and NaHCO 3 exerts a better antioxidative effect, which reduces the harmful short-term and long-term consequences of contrast media. Previous studies revealed the use of low-to-zero contrast media was safer in CKD patients who had undergone PCI. By applying these measures, our study showed a good outcome of PCI with no worsening renal function in CKD patients.Conclusion: With good prophylaxis measures, such as using minimal volume contrast media, adequate rehydration, and the combi...

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