Author + information
- Şükrü Akyüz1,
- Barış Güngör1,
- Barış Yaylak2,
- Selçuk Yazıcı1,
- Ahmet Ekmekçi1,
- Kıvılcım Özden1,
- Gültekin Karakuş3,
- Mehmet Karaca1,
- Tuğba Kemaloğlu Öz1,
- Servet Altay1 and
- Neşe Çam1
Contrast-induced acute kidney injury (CI-AKI) is a serious complication associated with the use of iodinated contrast medium (CM). Intravascular volume expansion by intravenous (I.V.) route is the only protective approach with proven efficacy in preventing CI-AKI. However, efficacy of oral volume expansion, or oral hydration, which shortens the duration of hospitalization, is less expensive and increases patient comfort, has not been well established. The objective of this study was to evaluate the efficacy of oral hydration in the prevention of CI-AKI
We prospectively randomized 225 patients undergoing coronary angiography and/or percutaneous coronary intervention with a non-ionic, low-osmolality contrast media in two different volume expansion strategies, oral hydration vs. I.V. hydration. Patients at high risk of developing CI-AKI [age ≥70 years old, diabetes mellitus, anemia, hyperuricemia, a history of cardiac failure or systolic dysfunction (ejection fraction <%40)] were included in the study. All patients had an estimated glomerular filtration rate of ≥60 mL/min/1.73 m2 [ i.e., normal renal function or stages 1 and 2 chronic kidney disease (CKD)]. Patients in the oral hydration group, except for those with cardiac failure, were recommended to consume fluids freely whereas isotonic saline (0.9%) was administered intravenously at a rate of 1 mL/kg/h for 12 hours before and 12 hours after the administration of CM in the I.V. hydration group. The primary outcome was the occurrence of CI-AKI which was defined as ≥25% increase in serum creatinine from the baseline at 48 hours in the absence of an alternative etiology.
CI-AKI occurred in 8/116 patients (6.9%) in the oral group and 8/109 patients (7.3%) in the I.V. group (p=0.89) (Table 1 and 2). When different CI-AKI definitions were taken into account, there was also no statistically significant difference between the two groups despite a high variability in the incidence of CI-AKI.
Oral hydration is as effective as I.V. hydration in the prevention of CI-AKI in patients with normal kidney function or with stages 1 and 2 CKD and who have also one of the other high risk factors such as advanced age, diabetes mellitus, anemia, hyperuricemia, a history of heart failure or systolic dysfunction.
|With CI-AKI||Without CI-AKI||p|
|Preprocedure SCr, mg/dL||0.90 (IQR 0.55)||0.90 (IQR 0.30)||0.39|
|Preprocedure eGFR, mL/min/1.73 m2||84.2±29.6||82.3±24.1||0.49|
|Total volume of hydration, mL||3075±1150||3130 ±1040||0.86|
|Amount of the contrast media, mL||120±88||106 ± 71||0.51|
CI-AKI indicates contrast-induced acute kidney injury; IQR, interquartile range; SCr, serum creatinine; eGFR, estimated glomerular filtration rate
|Oral Group (N=116), n (%)||I.V. Group (N=109), n (%)||p|
|SCr increase by ≥25%||8 (6.9)||8 (7.3)||0.89|
|SCr increase by 0.5 mg/dL||1 (0.8)||3 (2.7)||0.29|
|SCr increase by ≥50%||3 (2.6)||3 (2.8)||0.94|
|SCr increase by 0.3 mg/dL||8 (6.9)||8 (7.3)||0.89|
|eGFR decrease by ≤25%||17 (14.6)||10 (9.2)||0.21|
CI-AKI indicates contrast-induced acute kidney injury; I.V.; intravenous; SCr, serum creatinine; eGFR, estimated glomerular filtration rate.