Abstract 12835: Randomized Study of Short Prehydration with Sodium Bicarbonate versus Standard Pre- and Posthydration with Sodium Chloride to Prevent Contrast Induced Acute Kidney Injury: The Salina Trial

Abstract

Introduction Per year, millions of patients with renal impairment worldwide receive intravascular administration of contrast media, requiring hospitalization for hydration.

Aim To analyze whether 1 hour prehydration with 250ml, 1.4% sodium bicarbonate (Na-bic) is non-inferior to 4-12 hours pre- and posthydration with 1000ml 0.9% sodium chloride (NaCl) in preventing contrast induced acute kidney injury (CI-AKI) in patients with a GFR<60 ml/min undergoing intravenous contrast-enhanced computed tomography(CT).

Methods Primary outcome of this randomized trial was the increase in serum creatinine 48-96 hours post CT. Secondary outcomes were the incidence of CI-AKI (increase in serum creatinine >25%/>0.5mg/dl), recovery of renal function, and the need for dialysis. The Na-bic regime was considered non-inferior if the mean relative serum creatinine increase did not exceed 115% compared with the NaCl group.

Results From 2010-2012, 575 patients were randomized, of whom 500 completed follow-up. In the majority of the 75 remaining patients CT was cancelled or performed without contrast. There were no differences between both groups in patient characteristics and comorbidities(mean GFR 45ml/min, range14-59). Mean increase in serum creatinine in the Na-bic arm was 0.6%(SD14.0) and -2.0%(SD13.6) in the NaCl arm, mean difference 2.6%(95%CI0.1-5.0). The incidence of CI-AKI was 3.3%(95%CI1.1-5.6) in the Na-bic vs. 3.7%(95%CI1.3-6.1,p=NS) in the NaCl arm and renal function recovered to baseline value 2 months after CT in 87.5%(95%CI50.8-99.9%) and 77.8% of patients (95%CI44.3-94.6%,p=NS), respectively. None of the patients developed a need for dialysis.

Conclusion Prehydration with Na-bic was non-inferior to pre- and posthydration with NaCl, with a similar risk of CI-AKI in both groups. Therefore, short Na-bic prehydration can be safely used in daily practice, which will lead to a strong reduction in hospital stay.