Prevention of Contrast Media–Associated Nephropathy

Randomized Comparison of 2 Hydration Regimens in 1620 Patients Undergoing
Coronary Angioplasty

Author Information <http://archinte.ama-assn.org/issues/v162n3/abs/#aainfo>
Christian Mueller, MD; Gerd Buerkle, MD; Heinz J. Buettner, MD; Jens
Petersen, MD; André P. Perruchoud, MD; Urs Eriksson, MD, PhD; Stephan
Marsch, MD, PhD; Helmut Roskamm, MD
Background  The administration of radiographic contrast agents remains an
important cause of acute renal failure. The optimal infusion for hydration
has not been evaluated.
Objective  To compare the incidence of contrast media–associated
nephrotoxicity with isotonic or half-isotonic hydration.
Design  Prospective, randomized, controlled, open-label study.
Methods  Patients scheduled for elective or emergency coronary angioplasty
were randomly assigned to receive isotonic (0.9% saline) or half-isotonic
(0.45% sodium chloride plus 5% glucose) hydration beginning the morning of
the procedure for elective interventions and immediately before emergency
interventions. An increase in serum creatinine of at least 0.5 mg/dL (44
µmol/L) within 48 hours was defined as contrast media–associated
nephrotoxicity. Secondary end points were cardiac and peripheral vascular
complications.
Results  A total of 1620 patients were assigned to receive isotonic (n =
809) or half-isotonic (n = 811) hydration. Primary end point analysis was
possible in 1383 patients. Baseline characteristics were well matched.
Contrast media–associated nephropathy was significantly reduced with
isotonic (0.7%, 95% confidence interval, 0.1%-1.4%) vs half-isotonic (2.0%,
95% confidence interval, 1.0%-3.1%) hydration (P = .04). Three predefined
subgroups benefited in particular from isotonic hydration: women, persons
with diabetes, and patients receiving 250 mL or more of contrast. The
incidence of cardiac (isotonic, 5.3% vs half-isotonic, 6.4%; P = .59) and
peripheral vascular (isotonic, 1.6% vs half-isotonic, 1.5%, P = .93)
complications was similar between the 2 hydration groups.
Conclusion  Isotonic hydration is superior to half-isotonic hydration in the
prevention of contrast media–associated nephropathy.
Arch Intern Med. 2002;162:329-336


Edward E. Rylander, M.D.
Diplomat American Board of Family Practice.
Diplomat American Board of Palliative Medicine.