Withholding pre-hydration before contrast-enhanced CT seen as safe for patients with CKD
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Patients with chronic kidney disease who were not given pre-hydration prior to undergoing contrast-enhanced CT experienced outcomes similar to those who were given sodium bicarbonate pre-hydration, according to study results. This led researchers to conclude withholding pre-hydration is safe, as well as cost-effective.
“Although hydration protocols to prevent [post-contrast AKI] PC-AKI have been implemented in daily clinical practice for more than a decade, there is a lack of evidence for the effectiveness of these costly measures, and the magnitude of possible adverse effects, including volume overload in patients with congestive heart failure, is largely unknown,” Rohit J. Timal, MD, of Leiden University Medical Center in the Netherlands, and colleagues wrote.
They argued that patients have a low risk for development of post-contrast AKI and, thus, “the question [of] whether it is useful to take [such] preventive measures” should be addressed.
To this end, 523 patients with stage 3 CKD were randomized to receive no pre-hydration or pre-hydration with 250 mL of 1.4% sodium bicarbonate before undergoing the procedure. Compared with baseline, investigators found the mean relative increase in serum creatinine 2 to 5 days after contrast administration was similar between groups (3% in no pre-hydration group vs. 3.5% in the pre-hydration group). In addition, post-contrast AKI was observed in 2.1% of patients in the no pre-hydration group vs. 1.5% in the pre-hydration group, resulting in a relative risk of 1.7. No patients in either group required dialysis or developed acute heart failure.
Researchers also found withholding pre-hydration was cost-effective, as mean hydration costs were determined to be $143.94 per person vs. $0 per person with no pre-hydration. The researchers added that withholding pre-hydration did not increase health care expenses in the 2 months of follow-up.
“Based on these results,” they wrote, “we believe that our study provides sufficient evidence that preventive hydration can be withheld in this population.” – by Melissa J. Webb
Disclosures: Timal reports receiving grants from Stichting Achmea Gezondheidszorg. Please see the study for all other authors’ relevant financial disclosures.
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