title: Randomised trial of no hydration vs. sodium bicarbonate hydration in patients with chronic kidney disease undergoing acute computed tomography-pulmonary angiography.
abstract: BACKGROUND
  Hydration to prevent contrast-induced acute kidney injury (CI-AKI) induces a diagnostic delay when performing computed tomography-pulmonary angiography (CTPA) in patients suspected of having acute pulmonary embolism.
  
  
  OBJECTIVE
  To analyze whether withholding hydration is non-inferior to sodium bicarbonate hydration before CTPA in patients with chronic kidney disease (CKD).
  
  
  METHODS
  We performed an open-label multicenter randomized trial between 2009 and 2013. One hundred thirty-nine CKD patients were randomized, of whom 138 were included in the intention-to-treat population: 67 were randomized to withholding hydration and 71 were randomized to 1-h 250 mL 1.4% sodium bicarbonate hydration before CTPA. Primary outcome was the increase in serum creatinine 48-96 h after CTPA. Secondary outcomes were the incidence of CI-AKI (creatinine increase > 25%/> 0.5 mg dL(-1) ), recovery of renal function, and the need for dialysis within 2 months after CTPA. Withholding hydration was considered non-inferior if the mean relative creatinine increase was ≤ 15% compared with sodium bicarbonate.
  
  
  RESULTS
  Mean relative creatinine increase was -0.14% (interquartile range -15.1% to 12.0%) for withholding hydration and -0.32% (interquartile range -9.7% to 10.1%) for sodium bicarbonate (mean difference 0.19%, 95% confidence interval -5.88% to 6.25%, P-value non-inferiority < 0.001). CI-AKI occurred in 11 patients (8.1%): 6 (9.2%) were randomized to withholding hydration and 5 (7.1%) to sodium bicarbonate (relative risk 1.29, 95% confidence interval 0.41-4.03). Renal function recovered in 80.0% of CI-AKI patients within each group (relative risk 1.00, 95% confidence interval 0.54-1.86). None of the CI-AKI patients developed a need for dialysis.
  
  
  CONCLUSIONS
  Our results suggest that preventive hydration could be safely withheld in CKD patients undergoing CTPA for suspected acute pulmonary embolism. This will facilitate management of these patients and prevents delay in diagnosis as well as unnecessary start of anticoagulant treatment while receiving volume expansion.
authors.affiliation: Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Kooiman
authors.forename: Y W J
authors.initials: YW
authors.lastname: Sijpkens
authors.forename: M
authors.initials: M
authors.lastname: van Buren
authors.forename: J H M
authors.initials: JH
authors.lastname: Groeneveld
authors.forename: S R S
authors.initials: SR
authors.lastname: Ramai
authors.forename: A J
authors.initials: AJ
authors.lastname: van der Molen
authors.forename: N J M
authors.initials: NJ
authors.lastname: Aarts
authors.forename: C J
authors.initials: CJ
authors.lastname: van Rooden
authors.forename: S C
authors.initials: SC
authors.lastname: Cannegieter
authors.forename: H
authors.initials: H
authors.lastname: Putter
authors.forename: T J
authors.initials: TJ
authors.lastname: Rabelink
authors.forename: M V
authors.initials: MV
authors.lastname: Huisman
mesh_terms: D000368:Aged; D000792:Angiography; D003287:Contrast Media / Q000737:chemistry; D003404:Creatinine / Q000097:blood; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000188:drug therapy*; D008168:Lung / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D017693:Sodium Bicarbonate / Q000737:chemistry*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000150:complications* / Q000628:therapy; D014867:Water / Q000737:chemistry
chemical_list: D003287:Contrast Media; D014867:Water; D017693:Sodium Bicarbonate; D003404:Creatinine
keywords: acute kidney injury; multidetector computed tomography; prevention & control; pulmonary embolism; randomized controlled trial; venous thrombosis