Short versus conventional hydration for prevention of kidney injury during pre-TAVI computed tomography angiography.
Neth Heart J
; 26(9): 425-432, 2018 Sep.
Article
de En
| MEDLINE
| ID: mdl-30039383
ABSTRACT
BACKGROUND:
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 (1â¯h, 3â¯ml/kg/h sodium bicarbonate) hydration protocol is not inferior to conventional (24â¯h, 1â¯ml/kg/h saline) hydration in avoiding a decline in renal function in patients with impaired renal function. METHODS ANDRESULTS:
Single-centre randomised non-inferiority trial in patients with impaired renal function who underwent pre-TAVI CTA. Patients were randomised on a 11 ratio to short hydration (SHORT; 1â¯h sodium bicarbonate, 3â¯ml/kg/h) or conventional hydration (CONV; 24â¯h saline, 1â¯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⯵mol/l (95% CI 2.5-9.3) in the SHORT versus 2⯵mol/l (95% CI-1.4 to 6.3) in the CONV arm (pâ¯= 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%, pâ¯= 0.091).CONCLUSION:
For patients with impaired renal function undergoing pre-TAVI CTA, a short 1h, low-volume hydration protocol with sodium bicarbonate is not inferior to conventional 24-h, high-volume saline hydration.
Texte intégral:
1
Collection:
01-internacional
Base de données:
MEDLINE
Type d'étude:
Clinical_trials
Langue:
En
Journal:
Neth Heart J
Année:
2018
Type de document:
Article
Pays d'affiliation:
Pays-Bas