What is the role of hydration in the prevention of contrast-induced nephropathy (CIN)?

Updated: Dec 18, 2018
  • Author: Anita Basu, MD, FACP; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Answer

The first study revealing the benefit of hydration in CIN prevention came from Solomon et al. [34] They also found forced diuresis to be inferior to hydration with 0.45% saline. Fluids with different compositions and tonicity have since been studied, as well as the addition of bicarbonate and mannitol.

Normal saline has been found to be superior to half-normal saline in terms of its enhanced ability to produce intravascular volume expansion. It also increases delivery of sodium to the distal nephron, prevents renin-angiotensin activation, and thus maintains increased renal blood flow. In terms of route of administration, oral fluids, while beneficial, have not been considered as effective as intravenous hydration. [35, 36]  

Previously, there have been no studies comparing no prophylaxis vs hydration.However, data from the recent  phase 3 trial AMACING  found no prophylaxis to be non-inferior and cost-saving in preventing contrast-induced nephropathy compared with intravenous hydration. [37]


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