Comparison of Intravenous and Oral Hydration in the Prevention of Contrast-Induced Acute Kidney Injury in Low-Risk Patients: A Randomized Trial.
OBJECTIVE
Contrast-induced acute kidney injury (CI-AKI) is a common cause of renal failure. We evaluated the effectiveness of oral sodium citrate versus intravenous (IV) sodium bicarbonate for CI-AKI prophylaxis as well as their influence on kidney injury biomarkers.


METHODS
A randomized, controlled, single-center study including 130 hospitalized patients (62.3% men), who were randomized to receive sodium bicarbonate (1/6 men, 3 ml/kg/h for 1 h; n = 43), oral sodium citrate (75 ml/10 kg divided into 4 doses; n = 43) or nonspecific hydration (n = 44) before contrast administration, was conducted. Serum creatinine and kidney injury biomarkers (cystatin C, neutrophil gelatinase-associated lipocalin, interleukin-8, F2-isoprostanes and cardiotrophin-1 [CT-1]) were assessed.


RESULTS
Incidence of CI-AKI was 9.2% with no differences found between hydration groups: 7.0% in sodium bicarbonate group, 11.6% in oral sodium citrate group and 9.1% in the nonspecific hydration group. Urinary creatinine and urinary CT-1/creatinine ratio decreased 4 h after contrast infusion (p < 0.001), but none of the biomarkers assessed were affected by the treatments.


CONCLUSIONS
There were no differences in hydration with oral sodium citrate and IV sodium bicarbonate for the prophylaxis of CI-AKI. Therefore, oral hydration represents a safe, inexpensive and practical method for preventing CI-AKI in low-risk patients. No effect on biomarkers for kidney injury could be demonstrated.
Department of Nephrology, Clinica Universidad de Navarra, Pamplona, Spain.
Paloma L
PL
Martin-Moreno
Nerea
N
Varo
Eduardo
E
Martínez-Ansó
Nerea
N
Martin-Calvo
Carmen
C
Sayón-Orea
Jose I
JI
Bilbao
Nuria
N
Garcia-Fernandez
D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000517:prevention & control*; D061605:Administration, Intravenous; D000284:Administration, Oral; D000368:Aged; D015415:Biomarkers / Q000032:analysis; D002951:Citrates / Q000008:administration & dosage / Q000627:therapeutic use; D003287:Contrast Media / Q000009:adverse effects*; D003404:Creatinine / Q000097:blood / Q000652:urine; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D006801:Humans; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D017693:Sodium Bicarbonate / Q000008:administration & dosage / Q000627:therapeutic use; D000077559:Sodium Citrate
D015415:Biomarkers; D002951:Citrates; D003287:Contrast Media; D000077559:Sodium Citrate; D017693:Sodium Bicarbonate; D003404:Creatinine