For patients with chronic kidney disease, prehydration prior to contrast-enhanced computed tomography is unnecessary

Reference

Timal RJ, Kooiman J, Sijpkens YWJ, et al. Effect of no prehydration vs sodium bicarbonate prehydration prior to contrast-enhanced computed tomography in the prevention of postcontrast acute kidney injury in adults with chronic kidney disease. JAMA Intern Med 2020;180(4):533-541.

Synopsis

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).