Hydration Strategies for Preventing Contrast-Induced Acute Kidney Injury: A Systematic Review and Bayesian Network Meta-Analysis

Cai, Qiuping; Jing, Ran; Zhang, Wanfen; Tang, Yi; Li, Xiaoping; Liu, Tongqiang

doi:10.1155/2020/7292675

Cited by 15 publications

(7 citation statements)

References 87 publications

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“…Cai et al reviewed hydration strategies in 60 RCTs and performed a network meta-analysis to find an optimal strategy [ 124 ]. They reported that the RenalGuard system was best, followed by hemodynamic guidance monitoring for hydration.…”

Section: Managementmentioning

confidence: 99%

The Pathophysiology and the Management of Radiocontrast-Induced Nephropathy

Cho

2022

Diagnostics

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Contrast-induced nephropathy (CIN) is an impairment of renal function that occurs after the administration of an iodinated contrast medium (CM). Kidney dysfunction in CIN is considered transient and reversible in most cases. However, it is the third most common cause of hospital-acquired acute kidney injury and is associated with increased morbidity and mortality, especially in high-risk patients. Diagnostic and interventional procedures that require intravascular CM are being used with increasing frequency, especially among the elderly, who can be particularly susceptible to CIN due to multiple comorbidities. Therefore, identifying the exact mechanisms of CIN and its associated risk factors is crucial not only to provide optimal preventive management for at-risk patients, but also to increase the feasibility of diagnostic and interventional procedure that use CM. CM induces kidney injury by impairing renal hemodynamics and increasing the generation of reactive oxygen species, in addition to direct cytotoxicity. Periprocedural hydration is the most widely accepted preventive strategy to date. Here, we review the latest research results on the pathophysiology and management of CIN.

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Section: Managementmentioning

confidence: 99%

The Pathophysiology and the Management of Radiocontrast-Induced Nephropathy

Cho

2022

Diagnostics

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“…Although the effectiveness of hydration therapy has been well recognized, the agents, timing, dose, and velocity of optimal hydration strategy remain inconclusive 36 – 38 . Debates mainly focused on the choice of intravenous normal saline infusion or intravenous sodium bicarbonate infusion.…”

Section: Discussionmentioning

confidence: 99%

Admission electrolyte and osmotic pressure levels are associated with the incidence of contrast-associated acute kidney injury

Wang

et al. 2022

Sci Rep

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This retrospective study aimed to explore the relationships between electrolytes and osmotic pressure homeostasis with contrast-associated acute kidney injury (CA-AKI) risk in patients with percutaneous coronary intervention or coronary angiography. We totally enrolled 4386 hospitalized patients, who were categorized into five groups based on the predetermined cutoff values of electrolytes and osmotic pressure. CA-AKI was defined as an increase in serum creatine by 0.5 mg/dL (44.2 mol/L) or a 25% increase of the highest level post-operation compared to baseline. Multivariable logistic analysis was used to examine the association of CA-AKI incidence with electrolytes and osmotic pressure levels. Piecewise linear regression models and restricted cubic spline analysis were further utilized to determine the nonlinear relationship. The results showed U-shaped relationships between sodium, chloride, magnesium, and osmotic pressure levels and CA-AKI incidence. The lowest incidence was observed in the categories of 139–141.9 mmol/L, 107.0–109.9 mmol/L, 0.91–1.07 mmol/L, and 290.0–299.9 mOsm/kg, respectively. J-shaped associations were observed for potassium and phosphate levels and CA-AKI incidence, with the lowest incidence in the categories of 3.50–4.09 mmol/L and 0.96–1.28 mmol/L, respectively. A negative correlation was observed between calcium level and CA-AKI incidence, with the lowest CA-AKI risk in the category of ≥ 2.58 mmol/L. In conclusion, abnormally higher or lower sodium, chloride, magnesium, phosphate, and osmotic pressure levels on admission were associated with increased risks of CA-AKI. While for potassium and calcium, the status of hyperkalemia and hypocalcemia on admission showed more susceptibility for CA-AKI.

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“…Cai et al . [30] performed a meta-analysis of 60 PRCTs evaluating various fluid administration strategies for CA-AKI in 21 293 patients. Oral hydration and isotonic (0.9%) saline (IS) were each noninferior to no fluid administration in preventing CA-AKI and that when oral hydration was the reference, IS and NB were noninferior in prevention of CA-AKI.…”

Section: Fluid Administation Versus No Fluid Administationmentioning

confidence: 99%

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

Rudnick

Fay

Wahba

2022

Current Opinion in Nephrology &Amp; Hypertension

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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.

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Hydration Strategies for Preventing Contrast-Induced Acute Kidney Injury: A Systematic Review and Bayesian Network Meta-Analysis

Cited by 15 publications

References 87 publications

The Pathophysiology and the Management of Radiocontrast-Induced Nephropathy

The Pathophysiology and the Management of Radiocontrast-Induced Nephropathy

Admission electrolyte and osmotic pressure levels are associated with the incidence of contrast-associated acute kidney injury

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

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