Effect of No Prehydration vs Sodium Bicarbonate Prehydration Prior to Contrast-Enhanced Computed Tomography in the Prevention of Postcontrast Acute Kidney Injury in Adults With Chronic Kidney Disease

Timal, Rohit J.; Kooiman, Judith; Sijpkens, Yvo W.J.; Vries, Jean‐Paul P.M. de; Verberk-Jonkers, Iris J. A. M.; Brulez, Harald F.H.; Buren, Marjolijn van; Molen, Aart J. van der; Cannegieter, Suzanne C.; Putter, Hein; Hout, Wilbert B. van den; Jukema, J. Wouter; Rabelink, Ton J.; Huisman, Menno V.

doi:10.1001/jamainternmed.2019.7428

Cited by 45 publications

(37 citation statements)

References 37 publications

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“…[ 32 , 33 ] Conversely, however, the risk of inducing post-contrast acute kidney injury is overestimated. [ 34 ] Acute contrast-induced nephropathy is defined as the iatrogenic worsening of kidney function following the administration of IV radiocontrast – it usually shows a mild course with spontaneous return to baseline renal function without long-term compromise. As such, in patients with moderate to high probability for PE, we advocate not withholding CTPA as one of the most important diagnostic cornerstones.…”

Section: Diagnosismentioning

confidence: 99%

Pulmonary Embolism and Heart Failure: A Reappraisal

Arrigo

Huber

2021

Card Fail Rev

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Acute heart failure and acute pulmonary embolism share many features, including epidemiological aspects, clinical presentation, risk factors and pathobiological mechanisms. As such, it is not surprising that diagnosis and management of these common conditions might be challenging for the treating physician, in particular when both are concomitantly present. While helpful guidelines have been elaborated for both acute heart failure and pulmonary embolism, not many studies have been published on the coexistence of these diseases. With a special focus on diagnostic tools and therapeutic options, the authors review the available literature and, when evidence is lacking, present their own approach to the management of dyspnoeic patients with acute heart failure and pulmonary embolism.

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Section: Diagnosismentioning

confidence: 99%

Pulmonary Embolism and Heart Failure: A Reappraisal

Arrigo

Huber

2021

Card Fail Rev

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“…No prophylaxis was found non-inferior (PC-ASCI 5/70 vs. 6/65) [41]. This year a similar but larger study was published: the multi-center KOMPAS study included all CKD outpatients undergoing elective contrast-enhanced CT. Again, no prophylaxis was found non-inferior (PC-ASCI 7/262 vs. 4/261, no instances of dialysis and similar incidences of mortality at one-year follow-up) [42]. These three trials appear to indicate no benefit of prophylactic intravenous hydration in the elective setting of computed tomography.…”

Section: To Hydrate or Not To Hydrate? Intravenous Prophylactic Hydramentioning

confidence: 83%

Post-Contrast Acute Kidney Injury and Intravenous Prophylactic Hydration: An Update

Nijssen

Rennenberg

Nelemans

et al. 2020

Rofo

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Background Despite tremendous improvement in molecular properties over the last century, intravascular injection of iodinated contrast material may still have systemic and hemodynamic consequences. Patients with pre-existing renal insufficiency may be at risk for acute kidney injury, which may be associated with an increased risk of the need for dialysis and mortality in the long term. Many questions as to the physiological pathways, optimal definition, and incidence of contrast-induced acute kidney injury remain open. These uncertainties are reflected in the changing landscape of this field in terms of nomenclature, research, and clinical practice. Methods Clinical practice guidelines for the prevention of post-contrast acute kidney injury all recommend giving prophylaxis in the form of intravenous hydration to high-risk patients. Solid evidence for this strategy is lacking. This article gives an overview of the changing landscape of post-contrast acute kidney injury and prophylactic intravenous hydration, with the aim of supporting informed decision-making in clinical practice. Results Recent data have caused a shift in guideline recommendations: 90 % of patients formerly considered high-risk for contrast-induced acute kidney injury no longer qualify for prophylaxis. The remaining high-risk patients, with severe chronic kidney disease, represent a vulnerable population for whom intravenous hydration may provide some benefits but also carries risk. Conclusion Intravenous hydration may benefit ‘new’ high-risk patients. However, it also confers risk. A dual approach to screening patients will help avoid this risk in clinical practice. Key Points: Citation Format

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“…More recently, Timal et al 23 performed a randomized multicenter trial in 523 patients with stage 3 chronic kidney disease undergoing contrast-enhanced CT. Randomization to no hydration was noninferior to prehydration with bicarbonate in terms of postcontrast acute kidney injury, with event rates of 2.7% vs 1.5% respectively (relative risk 1.7, 95% CI 0.5-5.9). Noninferiority was also shown on subgroup analyses based on age, eGFR (30-44 vs 45-60 mL/min/1.73 m 2 ) alone or in combination with risk factors including diabetes.…”

Section: Volume Expansionmentioning

confidence: 99%