Abstract: SA-PO031

Oral Hydration to Prevent Contrast Induced Nephropathy

Session Information

Category: Acute Kidney Injury

  • 003 AKI: Clinical and Translational

Authors

  • Balemans, Corinne E.A., Radboud University Medical Center, Nijmegen, Netherlands
  • de Waal, Yvonne R.P., Radboud University Medical Center, Nijmegen, Netherlands
  • Ten Dam, Marc A.G.J., Canisius Wilhelmina Hospital , Nijmegen, Netherlands
  • Wetzels, Jack F., Radboud University Medical Center, Nijmegen, Netherlands
Background

Contrast Induced Nephropathy (CIN) complicates the use of iodinated contrast media. Guidelines advise intravenous hydration as preventive measure in high risk patients. However, i.v. hydration requires complicated logistics and is associated with high costs and adverse events (de Waal, ASN 2015). We showed in a small sized study that oral hydration might be as effective as i.v. hydration (Balemans, ASN 2015). We now report the efficacy of oral hydration in a large prospective cohort.

Methods

Two hospitals participated in the study. Between January 2015 and May 2017 high risk patients were screened and if eligible hydrated with sodiumchloride tablets 1g/10kg of body weight/day on day -2 and -1 before contrast exposure. Patients with eGFR <30ml/min/1.73m2, overt heart failure, Multiple Myeloma or an emergency procedure were excluded and hydrated intravenously with sodiumbicarbonate. We evaluated the incidence of CIN (defined as a rise in serum creatinine ≥25% or ≥44umol/L 48-96hrs after contrast injection) and adverse events.

Results

In the study period 927 radiological procedures were planned in high risk patients. 393 patients gave informed consent, 20 were lost to follow up, 10 CT scans were cancelled. We eventually evaluated 363 procedures, 99 patients were treated with iv hydration mainly because of heartfailure and eGFR < 30ml/min/1.73m2. 264 patients (30.7% female) received oral hydration, mean age 70.6±8.3 yrs, mean eGFR 44.1±7.1 ml/min/1.73m2.
The incidence of CIN after oral hydration was 3.0% (95%CI 1.44-5.97). In a historical control group, treated with iv hydration the incidence of CIN was 2.4% (95%CI 1.61-3.65) (Balemans, Radiology 2012).The main adverse event in the oral hydration group was nausea, in one case leading to conversion to iv hydration. One case of overhydration was reported (0.4%) compared to 12/490 (2.4%) after i.v. hydration (de Waal, ASN 2015)

Conclusion

Oral hydration is as effective as intravenous hydration in preventing CIN and can be used safely.
Oral hydration obviates the need for hospital admission, and thus reduces costs.

Funding

  • Government Support - Non-U.S.