Chest
Volume 114, Issue 6, December 1998, Pages 1570-1574
Journal home page for Chest

Clinical Investigations
Cardiology
PREPARED: PREParation for Angiography in REnal Dysfunction: A Randomized Trial of Inpatient vs Outpatient Hydration Protocols for Cardiac Catheterization in Mild-to-Moderate Renal Dysfunction

https://doi.org/10.1378/chest.114.6.1570Get rights and content

Background

IV hydration before and after cardiac catheterization is effective in preventing contrast-associated renal dysfunction for patients with mild-to-moderate renal insufficiency, but necessitates overnight hospital admission. We tested an outpatient oral precatheterization hydration strategy in comparison with overnight IV hydration.

Methods

We randomized 36 patients with renal dysfunction (serum creatinine ≥1.4 mg/dL) undergoing elective cardiac catheterization to receive either overnight IV hydration (0.45 normal saline solution at 75 mL/h for both 12 h precatheterization and postcatheterization; n = 18) or an outpatient hydration protocol including precatheterization oral hydration (1,000 mL clear liquid over 10 h) followed by 6 h of IV hydration (0.45 normal saline solution at 300 mL/h) beginning just before contrast exposure. The predefined primary end point was the maximal change in creatinine up to 48 h after cardiac catheterization.

Results

The inpatient and outpatient groups were well matched for baseline characteristics and contrast volume. By protocol design, the outpatient group received a greater volume of hydration, although the net volume changes were comparable in the two groups. The maximal changes in serum creatinine in the inpatient (0.21 ± 0.38 mg/dL; 95% confidence interval [CI], 0.02 to 0.39 mg/dL) and outpatient groups (0.12 ± 0.23 mg/dL; 95% CI, 0.01 to 0.24 mg/dL) were comparable (p = not significant). There were no instances of protocol intolerance.

Conclusions

A hydration strategy compatible with outpatient cardiac catheterization is comparable to precatheterization and postcatheterization IV hydration in preventing contrast-associated changes in serum creatinine. Hospital admission for IV hydration is unnecessary before elective cardiac catheterization in the setting of mild-to-moderate renal dysfunction.

Section snippets

Materials and Methods

The protocol was approved by the Human Use Committee/Clinical Investigation Committee, Department of Clinical Investigation, at Walter Reed Army Medical Center. Patients with a serum creatinine concentration of between 1.4 (the upper reference limit for our laboratory) and 3.0 mg/dL or calculated rates of creatinine clearance9 between 25 and 60 mL/min who were scheduled for elective cardiac catheterization were eligible for this study. The upper limit of serum creatinine of 3.0 mg/dL was chosen

Results

Baseline characteristics for the 36 study patients are displayed in Table 1. The mean age was 70 ± 8 years, and 29 of the 36 patients were men. Patients in the inpatient and outpatient fluid arms were well matched with respect to age, cardiovascular diagnosis, and use of angiotensin-converting enzyme (ACE) inhibitors or nonsteroidal agents. Fourteen patients had diabetes mellitus (six patients in the outpatient group and eight in the inpatient group; p = not significant [NS]). Baseline BUN,

Discussion

Contrast-associated deterioration in renal function is an uncommon but important complication of angiographic procedures. Past efforts to manage this potential risk have included a variety of interventions such as the use of different contrast media,2,6 or the administration of dopamine,7 calcium channel blockers,11 theophylline,8 mannitol, or furosemide.1,4 Among these, perhaps the most effective means of preventing CRD is adequate hydration. A previous randomized trial comparing IV hydration

References (11)

  • SolomonR et al.

    Effects of saline, mannitol, and furosemide to prevent acute decreases in renal function induced by radiocontrast agents

    N Engl J Med

    (1994)
  • BarrettBJ et al.

    Meta-analysis of the relative nephrotoxicity of high- and low-osmolality iodinated contrast media

    Radiology

    (1993)
  • WeisbergLS et al.

    Risk of radiocontrast nephropathy in patients with and without diabetes mellitus

    Kidney Int

    (1994)
  • LouisBM et al.

    Protection from the nephrotoxicity of contrast dye

    Ren Fail

    (1996)
  • RichMW et al.

    Incidence, risk factors, and clinical course of acute renal insufficiency after cardiac catheterization in patients 70 years of age or older: a prospective study

    Arch Intern Med

    (1990)
There are more references available in the full text version of this article.

Cited by (211)

  • Oral hydration compared to intravenous hydration in the prevention of post-contrast acute kidney injury in patients with chronic kidney disease stage IIIb: A phase III non-inferiority study (NICIR study)

    2021, European Journal of Radiology
    Citation Excerpt :

    The first meta-analysis conducted on this topic included studies where ionic iodinated contrast was used. Ionic iodinated contrast is not currently used due to its high nephrotoxicity, which could affect their overall conclusions [22,23]. Also, most patients included in these meta-analyses had normal or mild renal dysfunction, and oral hydration administration protocols varied from study to study, differing in hydration rate, time, and total volume, as well as the small number of patients included in most series [16,24–27].

  • Thoraco-abdominal aortic aneurysms: when and how to do it

    2021, Vascular Surgery: A Clinical Guide to Decision-making
  • Management of Renal Disorders and the Pharmacist's Role: Acute Kidney Injury

    2019, Encyclopedia of Pharmacy Practice and Clinical Pharmacy: Volumes 1-3
  • Management of renal disorders and the pharmacist’s role: Acute kidney injury

    2019, Encyclopedia of Pharmacy Practice and Clinical Pharmacy
View all citing articles on Scopus

This protocol was supported by the Department of Clinical Investigation, Walter Reed Army Medical Center, Washington, DC.

The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or reflecting the views of the United States Army or the Department of Defense.

View full text