Patients who have an estimated glomerular filtration rate (eGFR) of <30 mL/min/1.73 m2 are at a heightened risk of acute kidney injury after receiving intravenous iodinated contrast administration for computed tomography(CT).

In a trial conducted among 550 patients with mild-to-moderate chronic kidney disease (eGFR≥30 mL/min/1.73 m2)who underwent CT with intravenous contrast, post-contrast acute kidney injury occurred at similar frequency among those receiving, and not receiving, prophylactic volume expansion with intravenous sodium bicarbonate.

In the study, it was reported that among patients with stage 3 chronic kidney disease undergoing contrast-enhanced CT, reserving prehydration did not compromise patient safety. The results showed that the mean relative rise in creatinine level 2 to 5 days after contrast administration matched with baseline was 3.0% (10.5) in the no prehydration group versus 3.5% (10.3) in the prehydration group (mean difference, 0.5; 95% confidence interval [CI], -1.3 to 2.3; p <0.001 for noninferiority). Post-contrast acute kidney injury transpired in 11 patients (2.1%), including 7 of 262 (2.7%) in the no prehydration group and 4 of 261 (1.5%) in the prehydration group, which resulted in relative risk of 1.7 (95% CI, 0.5-5.9; p = 0.36). Mean hydration costs were €119 (US $143.94) per patient in the prehydration group compared with €0 (US $0) in the no prehydration group (p<0.001). Other healthcare costs were similar.

The results of this study support the alternative of not giving prehydration as safety and cost-effective measure.

Source

Timal RJ, et al. Effect of no prehydration vs sodium bicarbonate prehydration prior to contrast-enhanced computed tomography in the prevention of postcontrast acute kidney injury in adults with chronic kidney disease: The Kompas Randomized Clinical Trial. JAMA Intern Med. 2020;180(4):533-41.