Chest
Clinical InvestigationsCardiologyPREPARED: PREParation for Angiography in REnal Dysfunction: A Randomized Trial of Inpatient vs Outpatient Hydration Protocols for Cardiac Catheterization in 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
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Hydration to Prevent Contrast-Associated Acute Kidney Injury in Patients Undergoing Cardiac Angiography
2023, Interventional Cardiology ClinicsOral 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 RadiologyCitation 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].
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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.