Fluid cocktails and contrast nephropathy

Short Attention Span Summary

Nothing worked
Contrast induced nephropathy (CIN) following CT pulmonary angiogram (CTPA) was defined as an increase in creatinine 48-72 hours post-dose of >/= 25% or increase by 0.5 mg/dL.  Three IV fluid regimens were used for CIN prophylaxis: NS; NS + NAC; or NS + NaHCO3, all at 3 mL/kg one hour prior to CTPA and 1 mL/kg for 6 hours after.  CIN, as defined in the study, occurred in about 25% in each group and was not statistically significantly different, nor was in-hospital mortality (a secondary outcome), which occurred in about 12-13% in each group.  It's not clear whether this rise in creatinine in clinically significant.

Spoon Feed
None of the IV fluid regimens used for prophylaxis of CIN after CTPA made an impact on the development of CIN, which was around 25% regardless of which fluid was given.


Abstract

Acad Emerg Med. 2016 Oct;23(10):1136-1145. doi: 10.1111/acem.13051. Epub 2016 Sep 27.

The High Risk of Contrast-induced Nephropathy in Patients with Suspected Pulmonary Embolism Despite Three Different Prophylaxis: A Randomized Controlled Trial.

Turedi S1, Erdem E2, Karaca Y2, Tatli O2, Sahin A2, Turkmen S2, Gunduz A2.

Author information:

1Department of Emergency Medicine, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey. suleymanturedi@hotmail.com.

2Department of Emergency Medicine, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey.

Abstract

OBJECTIVE:

The objective was to compare the protective effects of N-acetylcysteine (NAC) plus normal saline (NS), sodium bicarbonate (NaHCO3 ) plus NS, and NS alone in the prevention of contrast-induced nephropathy (CIN) after computed tomography pulmonary angiography (CTPA) in emergency patients.

METHODS:

This study was planned as a randomized, controlled clinical research. Patients undergoing contrast-enhanced CTPA on suspicion of pulmonary embolism (PE) in the emergency department and with at least one risk factor for development of CIN were included in one of three different prophylaxis groups. The groups received 3 mL/kg intravenous (IV) NAC+NS or NaHCO3 +NS solution or NS alone 1 hour before CTPA and 1 mL/kg IV per hour for a minimum of 6 hours after CTPA. CIN was evaluated as the primary outcome and moderate or severe renal insufficiency and in-hospital mortality as secondary outcomes.

RESULTS:

A total of 257 patients were enrolled in the study. The total level of CIN development was 23.7% (61/257), the level of moderate and severe renal failure was 12.5% (32/257), and the in-hospital mortality rate was 12.8% (33/257). Rates of CIN development in the drug groups were 23.5% in the NAC group (20/85), 21.2% (18/85) in the NaHCO3 group, and 26.4% in the NS group (23/87). Rates of development of moderate or severe renal insufficiency were 9.4% in the NAC group (8/85), 10.6% in the NaHCO3 group (9/85), and 17.2% in the NS group (15/87). In-hospital mortality rates were 12.9% in the NAC group (11/85), 11.8% in the NaHCO3 group (10/85), and 13.8% in the NS group (12/87). No difference was determined between the drug groups in terms of CIN, moderate or severe renal injury, or hospital mortality.

CONCLUSIONS:

Our results indicate that there is a high risk of CIN in patients with suspected PE despite three different types of prophylaxis being administered, and no statistically significant differences were observed among prophylactic NAC, NaHCO3 , and NS in prevention of CIN following contrast-enhanced CTPA.

© 2016 by the Society for Academic Emergency Medicine.

PMID: 27411777 [PubMed - in process]