Abstract: FR-PO073
Chloride-Liberal vs. Chloride-Restrictive Intravenous Fluids to Prevent Contrast-Induced AKI
Session Information
- AKI: Clinical Outcomes, Trials
November 08, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Seibert, Felix S., University Hospital Marien Hospital Herne, Herne, Germany
- Westhoff, Timm H., University Hospital Marien Hospital Herne, Herne, Germany
Background
For decades plasma expansion by intravenous volume application constituted the central cornerstone in the prevention of contrast-induced acute kidney injury (CI-AKI) for patients with preexisting chronic kidney disease (CKD). The recent AMACING study challenged this approach and showed no benefit by isotonic saline solution. Consequently, several institutions have stopped prophylactic fluid application in CKD. Based on considerations regarding the tubuloglomerular feedback there are increasing data from intensive care and emergency room settings showing that chloride restrictive fluids might be superior to isotonic sale in the prevention of AKI.
Methods
Based on the above mentioned data, we changed our standard operating procedure for the management of CKD patients with contrast media enhanced computed tomography scans from periprocedural infusion of chloride-liberal to chloride-restrictive solutions. The present work compares the CI-AKI rates of the first n=100 CKD patients with Ringerlactat (Cl- concentration 112 mmol/l) or Jonosteril (Cl- concentration 110 mmol/l) to a historical cohort of 100 subjects with 0.9% saline solution as periprocedural fluid application (1l before and 1l after contrast application in each group). CI-AKI was defined as a ≥ 0.3 mg/dl increase of serum creatinine concentration from baseline to day 2-3 after radio contrast application.
Results
CI-AKI occurred in 14 subjects of the overall cohort (7%). The incidence of CI-AKI was 44% lower in those subjects receiving chloride-restrictive fluids (n=5, incidence 5%) than in those ones with isotonic saline application (n=9, incidence 9%) without reaching statistical significance (chi-squared p=0.27). In multiple logistic regression analysis, use of diuretics turned out to be an important risk factor for a periprocedural decrease of eGFR (B=-7.5). In contrast, the effects of congestive heart failure, diabetes, and use of inhibitors of the renin angiotensin system were below significance level.
Conclusion
The present analysis compares the potency of chloride-liberal vs. chloride-restrictive fluid application in the prevention of CI-AKI for the first time. It reveals a trend to a lower incidence of CI-AKI using chloride-restrictive fluid application and may thereby constitute a rationale for a sufficiently powered randomized prospective trial.