Prevention of contrast-induced acute kidney injury: is simple oral hydration similar to intravenous? A systematic review of the evidence.

<h4>Background</h4>Pre-procedural intravenous fluid administration is an effective prophylaxis measure for contrast-induced acute kidney injury. For logistical ease, the oral route is an alternative to the intravenous. The objective of this study was to compare the efficacy of the oral t...

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Autores principales:	Swapnil Hiremath, Ayub Akbari, Wael Shabana, Dean A Fergusson, Greg A Knoll
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2013
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/0eb1cb74020040ff976ca4f0a9fca6d0
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spelling	oai:doaj.org-article:0eb1cb74020040ff976ca4f0a9fca6d02021-11-18T07:51:53ZPrevention of contrast-induced acute kidney injury: is simple oral hydration similar to intravenous? A systematic review of the evidence.1932-620310.1371/journal.pone.0060009https://doaj.org/article/0eb1cb74020040ff976ca4f0a9fca6d02013-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/23555863/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background</h4>Pre-procedural intravenous fluid administration is an effective prophylaxis measure for contrast-induced acute kidney injury. For logistical ease, the oral route is an alternative to the intravenous. The objective of this study was to compare the efficacy of the oral to the intravenous route in prevention of contrast-induced acute kidney injury.<h4>Study design</h4>A systematic review and meta-analysis of randomised trials with a stratified analysis and metaregression. Databases included MEDLINE (1950 to November 23 2011), EMBASE (1947 to week 47 2011), Cochrane CENTRAL (3(rd) quarter 2011). Two reviewers identified relevant trials and abstracted data. SETTINGS AND POPULATION: Trials including patients undergoing a contrast enhanced procedure.<h4>Selection criteria</h4>Randomised controlled trial; adult (>18 years) population; comparison of oral versus intravenous volume expansion.<h4>Intervention</h4>Oral route of volume expansion compared to the intravenous route.<h4>Outcomes</h4>Any measure of acute kidney injury, need for renal replacement therapy, hospitalization and death.<h4>Results</h4>Six trials including 513 patients met inclusion criteria. The summary odds ratio was 1.19 (95% CI 0.46, 3.10, p = 0.73) suggesting no difference between the two routes of volume expansion. There was significant heterogeneity (Cochran's Q = 11.65, p = 0.04; I(2) = 57). In the stratified analysis, inclusion of the five studies with a prespecified oral volume expansion protocol resulted in a shift towards oral volume expansion (OR 0.75, 95% CI 0.37, 1.50, p = 0.42) and also resolved the heterogeneity (Q = 3.19, P = 0.53; I(2) = 0).<h4>Limitations</h4>Small number of studies identified; lack of hard clinical outcomes.<h4>Conclusion</h4>The oral route may be as effective as the intravenous route for volume expansion for contrast-induced acute kidney injury prevention. Adequately powered trials with hard endpoints should be done given the potential advantages of oral (e.g. reduced patient burden and cost) over intravenous volume expansion.Swapnil HiremathAyub AkbariWael ShabanaDean A FergussonGreg A KnollPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 8, Iss 3, p e60009 (2013)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Swapnil Hiremath Ayub Akbari Wael Shabana Dean A Fergusson Greg A Knoll Prevention of contrast-induced acute kidney injury: is simple oral hydration similar to intravenous? A systematic review of the evidence.
description	<h4>Background</h4>Pre-procedural intravenous fluid administration is an effective prophylaxis measure for contrast-induced acute kidney injury. For logistical ease, the oral route is an alternative to the intravenous. The objective of this study was to compare the efficacy of the oral to the intravenous route in prevention of contrast-induced acute kidney injury.<h4>Study design</h4>A systematic review and meta-analysis of randomised trials with a stratified analysis and metaregression. Databases included MEDLINE (1950 to November 23 2011), EMBASE (1947 to week 47 2011), Cochrane CENTRAL (3(rd) quarter 2011). Two reviewers identified relevant trials and abstracted data. SETTINGS AND POPULATION: Trials including patients undergoing a contrast enhanced procedure.<h4>Selection criteria</h4>Randomised controlled trial; adult (>18 years) population; comparison of oral versus intravenous volume expansion.<h4>Intervention</h4>Oral route of volume expansion compared to the intravenous route.<h4>Outcomes</h4>Any measure of acute kidney injury, need for renal replacement therapy, hospitalization and death.<h4>Results</h4>Six trials including 513 patients met inclusion criteria. The summary odds ratio was 1.19 (95% CI 0.46, 3.10, p = 0.73) suggesting no difference between the two routes of volume expansion. There was significant heterogeneity (Cochran's Q = 11.65, p = 0.04; I(2) = 57). In the stratified analysis, inclusion of the five studies with a prespecified oral volume expansion protocol resulted in a shift towards oral volume expansion (OR 0.75, 95% CI 0.37, 1.50, p = 0.42) and also resolved the heterogeneity (Q = 3.19, P = 0.53; I(2) = 0).<h4>Limitations</h4>Small number of studies identified; lack of hard clinical outcomes.<h4>Conclusion</h4>The oral route may be as effective as the intravenous route for volume expansion for contrast-induced acute kidney injury prevention. Adequately powered trials with hard endpoints should be done given the potential advantages of oral (e.g. reduced patient burden and cost) over intravenous volume expansion.
format	article
author	Swapnil Hiremath Ayub Akbari Wael Shabana Dean A Fergusson Greg A Knoll
author_facet	Swapnil Hiremath Ayub Akbari Wael Shabana Dean A Fergusson Greg A Knoll
author_sort	Swapnil Hiremath
title	Prevention of contrast-induced acute kidney injury: is simple oral hydration similar to intravenous? A systematic review of the evidence.
title_short	Prevention of contrast-induced acute kidney injury: is simple oral hydration similar to intravenous? A systematic review of the evidence.
title_full	Prevention of contrast-induced acute kidney injury: is simple oral hydration similar to intravenous? A systematic review of the evidence.
title_fullStr	Prevention of contrast-induced acute kidney injury: is simple oral hydration similar to intravenous? A systematic review of the evidence.
title_full_unstemmed	Prevention of contrast-induced acute kidney injury: is simple oral hydration similar to intravenous? A systematic review of the evidence.
title_sort	prevention of contrast-induced acute kidney injury: is simple oral hydration similar to intravenous? a systematic review of the evidence.
publisher	Public Library of Science (PLoS)
publishDate	2013
url	https://doaj.org/article/0eb1cb74020040ff976ca4f0a9fca6d0
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Prevention of contrast-induced acute kidney injury: is simple oral hydration similar to intravenous? A systematic review of the evidence.

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