Oral hydration for prevention of contrast-induced acute kidney injury in elective radiological procedures: a systematic review and meta-analysis of randomized controlled trials

Wisit Cheungpasitporn, Charat Thongprayoon, Brady A Brabec, Peter J Edmonds, Oisin A O'Corragain, Stephen B Erickson, Wisit Cheungpasitporn, Charat Thongprayoon, Brady A Brabec, Peter J Edmonds, Oisin A O'Corragain, Stephen B Erickson

Abstract

Background: The reports on efficacy of oral hydration treatment for the prevention of contrast-induced acute kidney injury (CIAKI) in elective radiological procedures and cardiac catheterization remain controversial.

Aims: The objective of this meta-analysis was to assess the use of oral hydration regimen for prevention of CIAKI.

Materials and methods: Comprehensive literature searches for randomized controlled trials (RCTs) of outpatient oral hydration treatment was performed using MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials Systematic Reviews, and clinicaltrials.gov from inception until July 4(th), 2014. Primary outcome was the incidence of CIAKI.

Results: Six prospective RCTs were included in our analysis. Of 513patients undergoing elective procedures with contrast exposures,45 patients (8.8%) had CIAKI. Of 241 patients with oral hydration regimen, 23 (9.5%) developed CIAKI. Of 272 patients with intravenous (IV) fluid regimen, 22 (8.1%) had CIAKI. Study populations in all included studies had relatively normal kidney function to chronic kidney disease (CKD) stage 3. There was no significant increased risk of CIAKI in oral fluid regimen group compared toIV fluid regimen group (RR = 0.94, 95% confidence interval, CI = 0.38-2.31).

Conclusions: According to our analysis,there is no evidence that oral fluid regimen is associated with more risk of CIAKI in patients undergoing elective procedures with contrast exposures compared to IV fluid regimen. This finding suggests that the oral fluid regimen might be considered as a possible outpatient treatment option for CIAKI prevention in patients with normal to moderately reduced kidney function.

Keywords: Contrast-Induced Acute Kidney Injury; Contrast-induced Nephropathy; Elective cardiac catheterization; Meta-analysis; Oral Hydration.

Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
Forest plot of the included studies comparing the risk of CIAKI in oral hydration and IV fluid regimens
Figure 2
Figure 2
Funnel plot of 6 studies to evaluate publication bias for the risk of CIAKI in patients receiving oral hydration regimen versus IV fluid regimen

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