Prevention of Contrast Media–Associated
Nephropathy
Randomized Comparison of 2 Hydration
Regimens in 1620 Patients Undergoing Coronary Angioplasty
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.