Oral Hydration and Alkalinization is Non-Inferior to Intravenous Therapy for Prevention of Contrast Induced Nephropathy in Patients With Chronic Kidney Disease.
Overview
- Phase
- Phase 4
- Intervention
- Intravenous Hydration
- Conditions
- Contrast Induced Nephropathy
- Sponsor
- The Western Pennsylvania Hospital
- Locations
- 1
- Primary Endpoint
- Contrast Induced Nephropathy
- Status
- Withdrawn
- Last Updated
- 6 years ago
Overview
Brief Summary
The increased risk for contrast-induced nephropathy (CIN) in patients with chronic kidney disease (CKD) undergoing coronary angiography (CAG) has been established. Current and historical data on CIN prevention strategies have shown wide variation with respect to the optimal type, route and timing of these therapies. We investigate the role for oral hydration and/or oral sodium bicarbonate administration compared to intravenous hydration and/or sodium bicarbonate in patients with CKD undergoing CAG.
Detailed Description
This is a single center study randomizing patients with CKD undergoing CAG into 4 groups: 1) Intravenous normal saline, 2) Intravenous normal saline and intravenous bicarbonate, 3) oral hydration, and 4) oral hydration and oral bicarbonate. The primary endpoint was the occurrence of contrast-medium-induced nephropathy defined as greater than 25% increase in serum creatinine from baseline or an absolute increase of 0.5 mg/dL from baseline at 72 hours following exposure to radiocontrast. Secondary endpoints include the length of hospitalization and in-house mortality.
Investigators
Eligibility Criteria
Inclusion Criteria
- •Stable serum creatinine levels of at least 1.1 mg/dL or estimated creatinine clearance less than 60 mL/min
- •Scheduled for diagnostic, elective cardiac angiography
Exclusion Criteria
- •Serum creatinine levels \>8.0 mg/dL
- •Change in serum creatinine levels of at least 0.5 mg/dL during the previous 24 hours
- •Preexisting dialysis
- •Multiple myeloma or other myeloproliferative disease
- •Current CHF or recent history of flash pulmonary edema
- •Current myocardial infarction
- •Symptomatic hypokalemia
- •Uncontrolled hypertension (treated systolic blood pressure \>200 mmHg or diastolic blood pressure \>100mmHg)
- •Exposure to radiocontrast within 7 days the study
- •Emergency Catheterization
Arms & Interventions
Intravenous Hydration
Pretreatment with a 3 mL/kg bolus of intravenous normal saline solution (154 mEq/L) over 1 hour, immediately prior to contrast exposure followed by intravenous infusion of 1ml/kg per for 6 hours after the procedure.
Intervention: Intravenous Hydration
Intravenous hydration and sodium bicarbonate
Pretreatment with a 3 mL/kg bolus of intravenous sodium bicarbonate solution (154 mEq/L) over 1 hour, immediately prior to contrast exposure followed by intravenous infusion of 1 mL/kg for 6 hours after the procedure.
Intervention: Intravenous Hydration
Intravenous hydration and sodium bicarbonate
Pretreatment with a 3 mL/kg bolus of intravenous sodium bicarbonate solution (154 mEq/L) over 1 hour, immediately prior to contrast exposure followed by intravenous infusion of 1 mL/kg for 6 hours after the procedure.
Intervention: Intravenous sodium bicarbonate
Oral hydration
Oral hydration with 500 mL of water to be started 4 hours prior to contrast exposure and stopped 2 hours prior to procedure followed by oral hydration with 600 mL of water post procedure
Intervention: Oral hydration
Oral hydration and oral sodium bicarbonate
Oral hydration with 500 mL of water to be started 4 hours prior to procedure and stopped 2 hours prior to contrast exposure, with the addition of 3.9 grams (46.4 mEq) of oral sodium bicarbonate to be given 20 minutes prior to contrast exposure followed by 1.95 grams (30.4 mEq) of oral sodium bicarbonate 2 hours and 4 hours after the initial dose
Intervention: Oral hydration
Oral hydration and oral sodium bicarbonate
Oral hydration with 500 mL of water to be started 4 hours prior to procedure and stopped 2 hours prior to contrast exposure, with the addition of 3.9 grams (46.4 mEq) of oral sodium bicarbonate to be given 20 minutes prior to contrast exposure followed by 1.95 grams (30.4 mEq) of oral sodium bicarbonate 2 hours and 4 hours after the initial dose
Intervention: Oral sodium bicarbonate
Outcomes
Primary Outcomes
Contrast Induced Nephropathy
Time Frame: 72 hours
Defined as greater than 25% increase in serum creatinine from baseline or an absolute increase of 0.5 mg/dL from baseline at 72 hours.
Secondary Outcomes
- Aspiration(72 hours)
- Hypotension(72 hours)
- Length of Hospital Stay(72 hours)
- In-Hospital Mortality(72 hours)