Fluid administration strategies for the prevention of contrast-associated acute kidney injury

Abstract

Purpose of reviewThe known timing of contrast media exposure in patients identified as high-risk for contrast-associated acute kidney injury (CA-AKI) enables the use of strategies to prevent this complication of intravascular contrast media exposure. Although multiple preventive strategies have been proposed, periprocedural fluid administration remains as the primary preventive strategy. This is a critical review of the current evidence evaluating a variety of fluid administration strategies in CA-AKI.Recent findingsFluid administration strategies to prevent CA-AKI include comparisons of intravenous (i.v.) to no fluid administration, different fluid solutions, duration of fluid administration, oral hydration, left ventricular end diastolic-pressure guided fluid administration and forced diuresis techniques.SummaryDespite an abundance of fluid administration trials, it is difficult to make definitive recommendations about preventive fluid administration strategies due to low scientific quality of published studies. The literature supports use of i.v. compared with no fluid administration, especially in high-risk patients undergoing intra-arterial contrast media exposure. Use of isotonic saline is recommended over 0.45% saline or isotonic sodium bicarbonate. Logistical considerations support shortened over longer i.v. fluid administration strategies, despite an absence of evidence of equivalent efficacy. Current literature does not support oral hydration for high-risk patients. The use of tailored fluid administration in heart failure patients and forced diuresis with matching fluid administration are promising new fluid administration strategies.

Intravenous fluid therapy in accordance with kidney injury risk: when to prescribe what volume of which solution

“…Contrast-induced nephropathy (CIN) may develop in patients with CKD that receive IV or intra-arterial iodinated contrast agents for imaging or therapeutic interventions. CIN may be prevented by administering 1 mL/kg/h hydration normal saline for 6–12 h both pre- and post-procedure unless the patient is already hypervolemic or receiving renal replacement therapy [ 52 , 53 ]. For urgent procedures, a higher dose (3 mL/kg/h) may be infused 1 h prior to and 6 h post-procedure.…”

The Prevalence and Indications of Intravenous Rehydration Therapy in Hospital Settings: A Systematic Review

“…Fluid loss can be caused by surgery, accident, or common conditions such as fever, vomiting, and diarrhoea. Moreover, in some cases requiring hospitalisation such as acute renal failure, hyponatremia, hypercalcemia, acute pancreatitis, and sepsis, which are more common in adults, IV rehydration is the most important part of the treatment and can be lifesaving, even if there is no loss of fluid [ 2 , 3 ]. In addition, IV hydration is used to maintain hydration in paediatric and adult cancer patients or terminal care patients who do not have adequate oral intake [ 4 ].…”

A Hidratação Oral pode ser uma Opção na Prevenção da Nefropatia Induzida por Contraste em Intervenções Coronárias Eletivas

“…A trial to assess its preventive effect on high-risk patients revealed substantial efficacy over hydration protocol for cardiac catheterization. 2,3 Among different drugs, nicorandil has been used in patients with chronic renal dysfunction. 4,5 We agree with the authors 1 that the most effective preventive measure to date is intravenous hydration (IVH).…”