Prophylactic intravenous prehydration with sodium bicarbonate or sodium chloride in the prevention of contrast induced acute kidney injury

Introduction: Iodinated contrast media is a crucial component in the diagnostic work up of many life-threatening illnesses. However, it has been reported to cause acute kidney injury after administration, especially in patients with pre-existing renal disease. Several prophylactic treatments have been studied in hopes of minimizing these adverse events. The current standard of care in this patient population is prophylactic intravenous volume administration with either sodium chloride or sodium bicarbonate. Objective: The goal of this literature review is to determine if prophylactic intravenous volume administration with either saline or sodium bicarbonate prior to contrast administration decreases the incidence of contrast induced acute kidney injury (CIAKI). Methods: A search of PubMed was performed using terms “kidney diseases/chemically induced” and “contrast media/adverse effects”. The limits applied included randomized control trials, published within the last 6 years, human subjects, and adult participants over age 18. Results: All three studies demonstrated that there was no statistically significant difference between prehydration and no prehydration in reducing the incidence of kidney injury. Conclusions: We recommend further studies be conducted with more standardized patient populations and a precise consensus of desired endpoint. While there are still several unanswered questions regarding the specific outcomes of renal injury after contrast use, the risk of CIAKI in patients with decreased kidney function does not appear to be any higher when prehydration is not used.