Prevention of contrast media-associated nephropathy: randomized comparison of 2 hydration regimens in 1620 patients undergoing coronary angioplasty.
BACKGROUND
The administration of radiographic contrast agents remains an important cause of acute renal failure. The optimal infusion for hydration has not been evaluated.


OBJECTIVE
To compare the incidence of contrast media-associated nephrotoxicity with isotonic or half-isotonic hydration.


METHODS
Prospective, randomized, controlled, open-label study.


METHODS
Patients scheduled for elective or emergency coronary angioplasty were randomly assigned to receive isotonic (0.9% saline) or half-isotonic (0.45% sodium chloride plus 5% glucose) hydration beginning the morning of the procedure for elective interventions and immediately before emergency interventions. An increase in serum creatinine of at least 0.5 mg/dL (44 micromol/L) within 48 hours was defined as contrast media-associated nephrotoxicity. Secondary end points were cardiac and peripheral vascular complications.


RESULTS
A total of 1620 patients were assigned to receive isotonic (n = 809) or half-isotonic (n = 811) hydration. Primary end point analysis was possible in 1383 patients. Baseline characteristics were well matched. Contrast media-associated nephropathy was significantly reduced with isotonic (0.7%, 95% confidence interval, 0.1%-1.4%) vs half-isotonic (2.0%, 95% confidence interval, 1.0%-3.1%) hydration (P =.04). Three predefined subgroups benefited in particular from isotonic hydration: women, persons with diabetes, and patients receiving 250 mL or more of contrast. The incidence of cardiac (isotonic, 5.3% vs half-isotonic, 6.4%; P =.59) and peripheral vascular (isotonic, 1.6% vs half-isotonic, 1.5%, P =.93) complications was similar between the 2 hydration groups.


CONCLUSIONS
Isotonic hydration is superior to half-isotonic hydration in the prevention of contrast media-associated nephropathy.
Mueller
Christian
C
Herz-Zentrum, Bad Krozingen, Germany. chmueller@uhbs.ch
Buerkle
Gerd
G
Buettner
Heinz J
HJ
Petersen
Jens
J
Perruchoud
André P
AP
Eriksson
Urs
U
Marsch
Stephan
S
Roskamm
Helmut
H
D058186:Acute Kidney Injury / Q000209:etiology / Q000517:prevention & control*; D000368:Aged; D000704:Analysis of Variance; D017130:Angioplasty / Q000009:adverse effects* / Q000379:methods; D016001:Confidence Intervals; D003287:Contrast Media / Q000009:adverse effects; D017023:Coronary Angiography / Q000009:adverse effects* / Q000379:methods; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000150:complications*; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D006801:Humans; D007677:Kidney Function Tests; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D011336:Probability; D011379:Prognosis; D011446:Prospective Studies; D012462:Saline Solution, Hypertonic / Q000008:administration & dosage; D012680:Sensitivity and Specificity; D012965:Sodium Chloride / Q000008:administration & dosage; D016896:Treatment Outcome
D003287:Contrast Media; D012462:Saline Solution, Hypertonic; D012965:Sodium Chloride