HYDRATION FOR CONTRAST-INDUCED ACUTE KIDNEY INJURY PREVENTION A META-ANALYSIS

Learning Objectives: The reports on efficacy of oral hydration compared to intravenous hydration for the prevention of contrast-induced acute kidney injury (CIAKI) in radiological procedures and cardiac catheterization remains controversial. The objective of this meta-analysis was to assess the efficacy of these hydration regimens for prevention of CIAKI. Methods: Comprehensive literature searches for randomized controlled trials (RCTs) of outpatient oral hydration treatment was performed using MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials Systematic Reviews and clinicaltrials.gov from inception until July 4th, 2014. Primary outcome was the incidence of CIAKI. Results: Three prospective RCTs were included in our analysis. Of 242 patients undergoing procedures with contrast exposures, 22 patients (9%) had CIAKI. These 3 RCTs, however, included only patients with relatively normal kidney function to CKD stage 3 and excluded those who had contrast exposure for urgent indications. There was no significant increased risk of CIAKI in oral fluid regimen group compared to IV fluid regimen group (RR = 1.83, 95% CI = 0.41–8.21). Conclusions: According to our analysis, there is no evidence that oral fluid regimen is associated with more risk of CIAKI in patients with contrast exposures compared to IV fluid regimen. This finding suggests that the oral fluid regimen is a possible treatment option for CIAKI prevention in non-urgent procedures in patients with normal to moderately reduced kidney function.

Duke Scholars

Author Narat Srivali Medicine, Pulmonary, Allergy, and Critical Care Medicine