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Question clinique
Should patients with chronic kidney disease receive hydration with sodium bicarbonate prior to intravenous contrast administration for elective computed tomography?
L’Essentiel
In patients with chronic kidney disease (CKD), withholding sodium bicarbonate prehydration prior to contrast-enhanced computed tomography (CT) does not worsen kidney function. 1b
Référence
Plan de l'etude: Randomized controlled trial (nonblinded)
Financement: Foundation
Cadre: Outpatient (primary care)
Sommaire
In this study, outpatients with stage 3 CKD undergoing nonemergent CT with intravenous contrast were randomized, using concealed allocation, to receive prehydration (n = 261) or no prehydration (n = 262). Inclusion criteria included stage 3B CKD, stage 3A CKD plus diabetes, or or at least 2 of the following risk factors: peripheral arterial disease, congestive heart failure, older than 75 years, anemia, contrast greater than 150 mL, or the use of nephrotoxic drugs. Baseline creatinine levels were obtained from both groups. The prehydration group received 250 mL of 1.4% bicarbonate intravenously over 1 hour prior to imaging. Follow-up creatinine levels were drawn at 2 to 5 days, 7 to 14 days, and 2 months after imaging. Postcontrast kidney injury was defined as an increase greater than 25% or an increase greater than 0.5 mg/dL in baseline creatinine level. The 2 groups had similar characteristics: their median age was 74 years and the most common causes of CKD were hypertension and diabetes. Analysis was by intention to treat. For the primary outcome of the mean increase in creatinine at 2 to 5 days after contrast, results were similar in the 2 groups (3.0% increase in no prehydration group vs 3.5% increase in prehydration group; risk difference 0.5, 95% CI -1.3 to 2.3; P < .001 for noninferiority).
Reviewer
Nita Shrikant Kulkarni, MD
Assistant Professor in Hospital Medicine
Northwestern University
Chicago, IL
Commentaires
imaging in a renal patient
That takes some of the worry out.
good information
good review
ct hydration
finally a non evidence based " heritage rule " being dismantled with solid clinical evidence.