20-Hour preprocedural hydration is not superior to 5-hour preprocedural hydration in the prevention of contrast-induced increases in serum creatinine and cystatin C.

BACKGROUND: Although intravenous hydration with isotonic saline is the standard therapy for the prevention of contrast-induced nephropathy (CIN), there is still insufficient evidence concerning the optimal timing to initiate preprocedural intravenous hydration with isotonic saline.

METHODS: This study prospectively compared the contrast-induced increases in serum creatinine and cystatin C between 5-hour preprocedural intravenous hydration with isotonic saline (5h-HS) and 20-hour preprocedural intravenous hydration with isotonic saline (20 h-HS) in 122 patients with renal insufficiency (estimated glomerular filtration rate of 15-60 ml/min/1.73 m(2)) undergoing an elective coronary procedure. The patients were randomly assigned to receive either 5h-HS (n=60) or 20 h-HS (n=62). Serum creatinine and cystatin C were measured at baseline, immediately before contrast exposure, and 24 hours and 48 hours after contrast exposure. The primary end points were the maximal absolute and percent changes in serum creatinine and cystatin C from the baseline up to 48 hours after contrast exposure.

RESULTS: The maximal absolute and percent changes in serum creatinine (0.01 ± 0.13 mg/dl vs. -0.03 ± 0.16 mg/dl, p=0.16; 0.87 ± 10.05% vs. -1.50 ± 12.92%, p=0.26; respectively) and cystatin C (-0.05 ± 0.17 mg/l vs. -0.06 ± 0.17 mg/l, p=0.59; -2.94 ± 9.29% vs. -3.46 ± 9.21%, p=0.75; respectively) did not differ between the 2 regimens.

CONCLUSIONS: 20 h-HS is not superior to 5h-HS in the prevention of the contrast-induced increases in serum creatinine and cystatin C in patients with renal insufficiency undergoing an elective coronary procedure.