THE SAFETY and cost-effectiveness of not giving prehydration to patients with chronic kidney disease (CKD) prior to a CT scan has been preliminary verified by a team of researchers. Dr Rohit Timal, Leiden University Medical Centre, Leiden, the Netherlands, and his colleagues have recently published a study showing evidence for omitting the 1-hour sodium bicarbonate infusion in patients, usually given to those with Stage III CKD who are undergoing a contrast-enhanced CT.
The multicentre, randomised clinical trial compared 523 patients on the effects of no prehydration to 250 mL of 1.4% sodium bicarbonate prehydration before the procedure. Dr Timal and colleagues found that the mean relative increase in serum creatine levels in the 2–5 days following contrast administration was 3.5% in the prehydration group, compared to 3.0% without prehydration. Of note, postcontrast acute kidney injury was seen in 11/523 patients, including four in the prehydration group and seven in the group without prehydration. Additionally, none of the patients required dialysis or developed acute heart failure highlighting the safety of the technique.
In terms of cost-effectiveness, the mean hydration costs per patient involved were calculated as €119 (USA $143.94), compared to €0 (USA $0) in the group without prehydration. Alongside this, the authors confirmed there was no subsequent increase in healthcare expenses at 2-month follow-up.
Dr Timal stated: “Although hydration protocols to prevent postcontrast AKI have been implemented in daily clinical practice for more than a decade, there is a lack of evidence for the effectiveness of these costly measures.” The authors of the study now hope that the study will sufficiently convince clinicians that withholding prehydration can be carried out safely in the CKD population, whilst simultaneously lowering the costs of such procedures.