Systematic oral hydration with water is similar to parenteral hydration for prevention of contrast-induced nephropathy: an updated meta-analysis of randomised clinical data

Abstract

BackgroundContrast-induced nephropathy (CIN) is the third most common cause of hospital-acquired kidney injury and is related to increased long-term morbidity and mortality. Adequate intravenous (IV) hydration has been demonstrated to lessen its occurrence. Oral (PO) hydration with water is inexpensive and readily available but its role for CIN prevention is yet to be determined.MethodsPubMed, EMBASE and the Cochrane Central register of controlled trials (CENTRAL) databases were searched until April 2015 and studies were selected using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. All randomised clinical trials with head-to-head comparison between PO and IV hydration were included.ResultsA total of 5 studies with 477 patients were included in the analysis, 255 of those receiving PO water. The incidence of CIN was statistically similar in the IV and PO arms (7.7% and 8.2%, respectively; relative risk 0.97; 95% CI 0.36 to 2.94; p=0.95). The incidence of CIN was statistically similar in the IV and PO arms in patients with chronic kidney disease and with normal renal function. Rise in creatinine at 48–72 h was lower in the PO hydration group compared with IV hydration (pooled standard mean difference 0.04; 95% CI 0.03 to 0.06; p<0.001; I2=62%).ConclusionsOur meta-analysis shows that systematic PO hydration with water is at least as effective as IV hydration with saline to prevent CIN. PO hydration is cheaper and more easily administered than IV hydration, thus making it more attractive and just as effective.

Post-contrast acute kidney injury. Part 2: risk stratification, role of hydration and other prophylactic measures, patients taking metformin and chronic dialysis patients

“…Nine studies evaluated oral hydration, but were limited by small patient numbers and by the absence of patients with severe renal impairment [ 39 , 41 – 48 ]. Three meta-analyses concluded that there is no evidence that oral hydration is associated with more risk of PC-AKI compared to IV hydration, but the studies were limited by heterogeneity and lack of hard clinical outcomes [ 49 – 51 ]. The CMSC does not recommend the use of oral hydration as the sole preventive strategy for PC-AKI, but unrestricted intake of clear oral fluids in addition to IV volume expansion is supported (Table 2 ).…”

Use of Intravenous Iodinated Contrast Media in Patients with Kidney Disease: Consensus Statements from the American College of Radiology and the National Kidney Foundation

“…However, longer intravenous protocols are generally impractical in the outpatient setting. Oral hydration has not been well studied for patients with eGFR less than 30 mL/min/1.73 m 2 or AKI (38,39).…”

Use of Intravenous Iodinated Contrast Media in Patients With Kidney Disease

“…Oral hydration has not been well studied for patients with eGFR less than 30 mL/min/1.73 m 2 or AKI. 38 , 39 …”