Prevention of Contrast-Induced Acute Kidney Injury: Is Simple Oral Hydration Similar To Intravenous? A Systematic Review of the Evidence

被引:62
作者
Hiremath, Swapnil [1 ,2 ]
Akbari, Ayub [1 ,2 ]
Shabana, Wael [3 ]
Fergusson, Dean A. [2 ]
Knoll, Greg A. [1 ,2 ]
机构
[1] Univ Ottawa, Fac Med, Div Nephrol, Ottawa, ON, Canada
[2] Ottawa Hosp, Res Inst, Clin Epidemiol Program, Ottawa, ON, Canada
[3] Univ Ottawa, Fac Med, Dept Med Imaging, Ottawa, ON, Canada
关键词
PERCUTANEOUS CORONARY INTERVENTION; ACUTE-RENAL-FAILURE; INDUCED NEPHROPATHY; SODIUM-BICARBONATE; CARDIAC-CATHETERIZATION; INDUCED NEPHROTOXICITY; SALINE HYDRATION; RANDOMIZED-TRIAL; RISK; ANGIOGRAPHY;
D O I
10.1371/journal.pone.0060009
中图分类号
O [数理科学和化学]; P [天文学、地球科学]; Q [生物科学]; N [自然科学总论];
学科分类号
07 ; 0710 ; 09 ;
摘要
Background: Pre-procedural intravenous fluid administration is an effective prophylaxis measure for contrast-induced acute kidney injury. For logistical ease, the oral route is an alternative to the intravenous. The objective of this study was to compare the efficacy of the oral to the intravenous route in prevention of contrast-induced acute kidney injury. Study Design: A systematic review and meta-analysis of randomised trials with a stratified analysis and metaregression. Databases included MEDLINE (1950 to November 23 2011), EMBASE (1947 to week 47 2011), Cochrane CENTRAL (3rd quarter 2011). Two reviewers identified relevant trials and abstracted data. Settings and Population: Trials including patients undergoing a contrast enhanced procedure. Selection Criteria: Randomised controlled trial; adult (. 18 years) population; comparison of oral versus intravenous volume expansion. Intervention: Oral route of volume expansion compared to the intravenous route. Outcomes: Any measure of acute kidney injury, need for renal replacement therapy, hospitalization and death. Results: Six trials including 513 patients met inclusion criteria. The summary odds ratio was 1.19 (95% CI 0.46, 3.10, p = 0.73) suggesting no difference between the two routes of volume expansion. There was significant heterogeneity (Cochran's Q = 11.65, p = 0.04; I-2 = 57). In the stratified analysis, inclusion of the five studies with a prespecified oral volume expansion protocol resulted in a shift towards oral volume expansion (OR 0.75, 95% CI 0.37, 1.50, p = 0.42) and also resolved the heterogeneity (Q = 3.19, P = 0.53; I-2 = 0). Limitations: Small number of studies identified; lack of hard clinical outcomes. Conclusion: The oral route may be as effective as the intravenous route for volume expansion for contrast-induced acute kidney injury prevention. Adequately powered trials with hard endpoints should be done given the potential advantages of oral (e. g. reduced patient burden and cost) over intravenous volume expansion.
引用
收藏
页数:9
相关论文
共 48 条
[1]  
[Anonymous], SYSTEMATIC REV HLTH
[2]  
[Anonymous], LOCATION CT SCAN CTR
[3]  
[Anonymous], GUID IOD CONTR ADM
[4]  
[Anonymous], ACR MAN CONTR MED
[5]   Sodium bicarbonate vs sodium chloride for the prevention of contrast medium-induced nephropathy in patients undergoing coronary angiography - A randomized trial [J].
Brar, Somjot S. ;
Shen, Albert Yuh-Jer ;
Jorgensen, Michael B. ;
Kotlewski, Adam ;
Aharonian, Vicken J. ;
Desai, Natasha ;
Ree, Michael ;
Shah, Ahmed Ijaz ;
Burchette, Raoul J. .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2008, 300 (09) :1038-1046
[6]   Sodium Bicarbonate for the Prevention of Contrast Induced-Acute Kidney Injury: A Systematic Review and Meta-analysis [J].
Brar, Somjot S. ;
Hirernath, Swapnil ;
Dangas, George ;
Mehran, Roxana ;
Brar, Simerjeet K. ;
Leon, Martin B. .
CLINICAL JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY, 2009, 4 (10) :1584-1592
[7]   Oral Hydration and Alkalinization is Noninferior to Intravenous Therapy for Prevention of Contrast-Induced Nephropathy in Patients with Chronic Kidney Disease [J].
Cho, Roy ;
Javed, Nosheen ;
Traub, Darren ;
Kodali, Sobhan ;
Atem, Folefac ;
Srinivasan, Venkatraman .
JOURNAL OF INTERVENTIONAL CARDIOLOGY, 2010, 23 (05) :460-466
[8]   DOSING OF CONTRAST MATERIAL TO PREVENT CONTRAST NEPHROPATHY IN PATIENTS WITH RENAL-DISEASE [J].
CIGARROA, RG ;
LANGE, RA ;
WILLIAMS, RH ;
HILLIS, LD .
AMERICAN JOURNAL OF MEDICINE, 1989, 86 (06) :649-652
[9]   METAANALYSIS IN CLINICAL-TRIALS [J].
DERSIMONIAN, R ;
LAIRD, N .
CONTROLLED CLINICAL TRIALS, 1986, 7 (03) :177-188
[10]  
Duggan C, 1992, MMWR Recomm Rep, V41, P1