Abstract 10195: 20-Hour Preprocedural Hydration is Not Superior to 5-Hour Preprocedural Hydration in the Prevention of Contrast-Induced Increases in Serum Creatinine and Cystatin C in Patients with Renal Insufficiency
Background: Although intravenous hydration with isotonic saline is the standard therapy for the prevention of contrast-induced nephropathy (CIN), there is still insufficient evidence concerning the optimal time to initiate preprocedural hydration with intravenous isotonic saline.
Methods: This study prospectively compared the contrast-induced increases in serum creatinine and cystatin C between 5-hour preprocedural intravenous hydration with isotonic saline (5h-HS) and 20-hour preprocedural intravenous hydration with isotonic saline (20h-HS) in 122 patients with renal insufficiency (estimated glomerular filtration rate of 15 - 60 ml/min/1.73 m2) undergoing an elective coronary procedure. The patients were randomly assigned to receive either 5h-HS (n = 60) or 20h-HS (n = 62). Serum creatinine and cystatin C were measured at baseline, immediately before contrast exposure, and 24 hours and 48 hours after contrast exposure. The primary end points were the maximal absolute and % changes in serum creatinine and cystatin C from the baseline up to 48 hours after contrast exposure. The secondary end point was the development of CIN, defined as a >25% or >0.5 mg/dl increase in serum creatinine from the baseline up to 48 hours after contrast exposure.
Results: The maximal absolute and % changes in serum creatinine (0.01 ± 0.13 mg/dl vs -0.03 ± 0.16 mg/dl, p = 0.16; 0.87 ± 10.05% vs -1.50 ± 12.92%, p = 0.26; respectively) and cystatin C (-0.05 ± 0.17 mg/l vs -0.06 ± 0.17 mg/dl, p = 0.59; -2.94 ± 9.29% vs -3.46 ± 9.21%, p = 0.75; respectively) did not differ between 5h-HS and 20-HS. The incidence of CIN did not differ between 5h-HS and 20h-HS (3.3% vs 3.2%).
Conclusions: 20h-HS is not superior to 5h-HS in the prevention of the contrast-induced increases in serum creatinine and cystatin C in patients with renal insufficiency undergoing an elective coronary procedure. Preprocedural intravenous hydration with isotonic saline started at least 5 hours before contrast exposure may be sufficient to prevent CIN in such patients.
- © 2011 by American Heart Association, Inc.