Swipe om te navigeren naar een ander artikel
The online version of this article (https://doi.org/10.1007/s12471-018-1133-1) contains supplementary material, which is available to authorized users.
Computed tomography angiography (CTA) is required in the work-up for transcatheter aortic valve implantation (TAVI). However, CTA may cause contrast-induced acute kidney injury (CI-AKI). We hypothesised that a short (1 h, 3 ml/kg/h sodium bicarbonate) hydration protocol is not inferior to conventional (24 h, 1 ml/kg/h saline) hydration in avoiding a decline in renal function in patients with impaired renal function.
Single-centre randomised non-inferiority trial in patients with impaired renal function who underwent pre-TAVI CTA. Patients were randomised on a 1:1 ratio to short hydration (SHORT; 1 h sodium bicarbonate, 3 ml/kg/h) or conventional hydration (CONV; 24 h saline, 1 ml/kg/h). Outcomes included percentage change in serum creatinine until 2–6 days after CTA with a non-inferiority margin of 10% and an increase on the Borg dyspnoea scale ≥1 point. Seventy-four patients were included. Increase in creatinine was 6 µmol/l (95% CI 2.5–9.3) in the SHORT versus 2 µmol/l (95% CI-1.4 to 6.3) in the CONV arm (p = 0.167). The percentage change was 4.6% (95% CI 2.0–7.3%) in the SHORT arm versus 2.5% (95% CI: 0.8 to 5.8%) in the CONV arm. The difference in percentage increase in creatinine between the two arms was 2.1% (95% CI: 2.0–6.2%; p-value non-inferiority: <0.001). CI-AKI and a need for dialysis were not observed. An increase of ≥1 point on the Borg scale (dyspnoea scale ranging from 1 (lowest) to 10 (highest)) was seen in 1 patient in the SHORT arm versus 5 patients in the CONV arm (2.9% vs 16.1%, p = 0.091).
For patients with impaired renal function undergoing pre-TAVI CTA, a short 1‑h, low-volume hydration protocol with sodium bicarbonate is not inferior to conventional 24-h, high-volume saline hydration.
Supplemental Table 1: Demographic and clinical characteristics of all patients who underwent randomization. Modified intention to treat (mITT)-population versus the randomized but excluded population12471_2018_1133_MOESM1_ESM.doc
Otto CM, Kumbhani DJ, Alexander KP, et al. 2017 ACC expert consensus decision pathway for transcatheter aortic valve replacement in the management of adults with aortic stenosis: a report of the American College of Cardiology task force on clinical expert consensus documents. J Am Coll Cardiol. 2017;69:1313–46. CrossRefPubMed
Fliser D, Laville M, Covic A, et al. A European Renal Best Practice (ERBP) position statement on the Kidney Disease Improving Global Outcomes (KDIGO) clinical practice guidelines on acute kidney injury: part 1: definitions, conservative management and contrast-induced nephropathy. Nephrol Dial Transplant. 2012;27:4263–72. CrossRefPubMedPubMedCentral
ACR Committee on Drugs and Contrast Media. Manual on Contrast Media v10.2. American College of Radiology. 2016
VMS Veiligheidsprogramma. Voorkomen van nierinsufficiëntie bij intravasculair gebruik van jodiumhoudende contrastmiddelen. 2009.
KDIGO CKD Work group. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl. 2013;3:1–150. CrossRef
Kooiman J, Sijpkens YW, de Vries JP, et al. A randomized comparison of 1‑h sodium bicarbonate hydration versus standard peri-procedural saline hydration in patients with chronic kidney disease undergoing intravenous contrast-enhanced computerized tomography. Nephrol Dial Transplant. 2014;29:1029–36. CrossRefPubMed
Nijssen EC, Rennenberg RJ, Nelemans PJ, et al. Prophylactic hydration to protect renal function from intravascular iodinated contrast material in patients at high risk of contrast-induced nephropathy (AMACING): a prospective, randomised, phase 3, controlled, open-label, non-inferiority trial. Lancet. 2017;389(10076):1312. https://doi.org/10.1016/S0140-6736(17)30057-0. CrossRefPubMed
Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P. Acute renal failure—definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care. 2004;8:R204–R12. CrossRefPubMedPubMedCentral
Working group of the Radiological Society of the Netherlands. Guideline safe use of contrast media—part 1. NVVR. 2017.
- Short versus conventional hydration for prevention of kidney injury during pre-TAVI computed tomography angiography
M. S. van Mourik
F. van Kesteren
R. N. Planken
E. M. A. Wiegerinck
J. J. Piek
J. G. Tijssen
M. G. Koopman
J. P. S. Henriques
J. Baan Jr.
M. M. Vis
- Bohn Stafleu van Loghum
- Netherlands Heart Journal
Print ISSN: 1568-5888
Elektronisch ISSN: 1876-6250