Abstract
BackgroundGuidelines advise periprocedural saline hydration for prevention of contrast induced-acute kidney injury (CI-AKI). We analysed whether 1-hour sodium bicarbonate hydration administered solely prior to intra-arterial contrast exposure is non-inferior to standard periprocedural saline hydration in chronic kidney disease (CKD) patients undergoing elective cardiovascular diagnostic or interventional contrast procedures.MethodsWe performed an open-label multicentre non-inferiority trial between 2011–2014. Patients were randomized to 1 hour pre-procedure sodium bicarbonate hydration (250 ml 1.4%, N = 168) or 4–12 hours saline hydration (1000 ml 0.9%, N = 165) prior to and following contrast administration (2000 ml of saline total). Primary outcome was the relative serum creatinine increase (%) 48–96 hours post contrast exposure. Secondary outcomes were: incidence of CI-AKI (serum creatinine increase>25% or >44μmol/L), recovery of renal function, the need for dialysis, and hospital costs within two months follow-up.ResultsMean relative creatinine increase was 3.1% (95%CI 0.9 to 5.2%) in the bicarbonate and 1.1% (95%CI -1.2 to 3.5%) in the saline arm, mean difference 1.9% (95%CI -1.2 to 5.1%, p-non-inferiority <0.001). CI-AKI occurred in 11 (6.7%) patients randomized to sodium bicarbonate and 12 (7.5%) to saline (p = 0.79). Renal function did not fully recover in 40.0% and 44.4% of CI-AKI patients, respectively (p = 0.84). No patient required dialysis. Mean costs for preventive hydration and clinical preparation for the contrast procedure were $1158 for sodium bicarbonate vs. $1561 for saline (p < 0.001).ConclusionShort hydration with sodium bicarbonate prior to elective cardiovascular diagnostic or therapeutic contrast procedures is non-inferior to standard periprocedural saline hydration in CKD patients with respect to renal safety and results in considerable healthcare savings.Trial registrationNetherlands Trial Register (http://www.trialregister.nl/trialreg/index.asp), Nr NTR2699
Highlights
Contrast induced-acute kidney injury (CI-AKI) is a common complication among patients undergoing cardiovascular diagnostic or interventional contrast procedures [1]
We analysed whether 1-hour sodium bicarbonate hydration administered solely prior to intra-arterial contrast exposure is non-inferior to standard periprocedural saline hydration in chronic kidney disease (CKD) patients undergoing elective cardiovascular diagnostic or interventional contrast procedures
Guidelines on the prevention of confidence intervals (CI)-AKI recommend the use of periprocedural intravenous saline (4–12 hours prior to and following contrast exposure) or sodium bicarbonate (1 hour prior to and 6 hours following contrast exposure) hydration in patients with chronic kidney disease (CKD), who are at high risk of developing CI-AKI [5,6,7]
Summary
Contrast induced-acute kidney injury (CI-AKI) is a common complication among patients undergoing cardiovascular diagnostic or interventional contrast procedures [1]. Guidelines on the prevention of CI-AKI recommend the use of periprocedural intravenous saline (4–12 hours prior to and following contrast exposure) or sodium bicarbonate (1 hour prior to and 6 hours following contrast exposure) hydration in patients with chronic kidney disease (CKD), who are at high risk of developing CI-AKI [5,6,7] Such use of CI-AKI preventive hydration is burdensome to patients and increases healthcare costs. The volume expansion of this short regime would prevent patients from being in a hypovolemic state at time of contrast administration, an important risk factor for CI-AKI It is unclear whether these results can be adopted to CKD patients undergoing elective cardiovascular diagnostic or interventional procedures requiring intra-arterial contrast administration. We analysed whether 1-hour sodium bicarbonate hydration administered solely prior to intra-arterial contrast exposure is non-inferior to standard periprocedural saline hydration in chronic kidney disease (CKD) patients undergoing elective cardiovascular diagnostic or interventional contrast procedures
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