Randomised trial of no hydration versus sodium bicarbonate hydration in patients with chronic kidney disease undergoing acute CT-pulmonary angiography.
J Thromb Haemost. 2014 Aug 20;
Authors: Kooiman J, Sijpkens Y, van Buren M, Groeneveld J, Ramai S, van der Molen A, Aarts N, van Rooden C, Cannegieter S, Putter H, Rabelink T, Huisman M
BACKGROUND: Hydration to prevent contrast induced-acute kidney injury (CI-AKI) induces a diagnostic delay when performing CT-pulmonary angiography (CTPA) in patients suspected of acute pulmonary embolism (PE).
AIM: To analyze whether withholding hydration is non-inferior to sodium bicarbonate hydration prior to CTPA in patients with chronic kidney disease (CKD).
METHODS: We performed an open-label multicenter randomized trial between 2009 and 2013. 139 CKD patients were randomized of whom 138 were included in the intention-to-treat population; 67 randomized to withholding hydration and 71 to one-hour 250ml 1.4% sodium bicarbonate hydration prior to CTPA. Primary outcome was the increase in serum creatinine 48-96 hours post CTPA. Secondary outcomes were the incidence of CI-AKI (creatinine increase >25%/>0.5mg/dl), recovery of renal function, and the need for dialysis within two months post CTPA. Withholding hydration was considered non-inferior if the mean relative creatinine increase was ≤15% compared with sodium bicarbonate. Mean relative creatinine increase was -0.14%(IQR-15.1 to 12.0%) for withholding hydration and -0.32%(IQR-9.7 to 10.1%) for sodium bicarbonate(mean difference 0.19%,95%CI-5.88 to 6.25%,p-value non-inferiority <0.001). CI-AKI occurred in 11 patients(8.1%); 6(9.2%) randomized to withholding hydration and 5(7.1%) to sodium bicarbonate (relative risk 1.29,95%CI0.41-4.03). Renal function recovered in 80.0% of CI-AKI patients within each group (relative risk 1.00,95%CI0.54-1.86). None of the CI-AKI patients developed a need for dialysis.
CONCLUSION: Our results suggest that preventive hydration could be safely withheld in CKD patients undergoing CTPA for suspected acute PE. This will facilitate management of these patients and prevents delay in diagnosis as well as unnecessary start of anticoagulant treatment while receiving volume expansion. This article is protected by copyright. All rights reserved.
PMID: 25142085 [PubMed - as supplied by publisher]