Journal of Interventional Cardiology

Review Article

Hydration Strategies for Preventing Contrast-Induced Acute Kidney Injury: A Systematic Review and Bayesian Network Meta-Analysis

Table 1

Characteristics of the included studies.


Studies	Patients (n)	Inclusion criteria/risk of CI-AKI	Mean age (years)	Males (%)	Baseline SCr (mg/dL)	Baseline eGFR (mL/min/1.73 m²)	Mean LVEF (%)	DM (%)	HF (%)	Treatment groups	Types of CM	CM dosage (mL)	Jadad score	No. of patients	Inclusion criteria/risk of CI-AKI	Mean age	Male (%)	Baseline SCr	Baseline eGFR	Mean LVEF	DM (%)	HF (%)	Groups	Types of CM	Dosage of CM	Jadad score

Weisbord et al. [11]	4993	High risk for renal complications and scheduled for angiography	69.8	93.6	132.6	50.2		80.9	7.4	SC vs. SB	Iodixanol or low-osmolar	85	5	4993	High risk for renal complications and scheduled for angiography	69.8	93.6	132.6	50.2		80.9	7.4	SC vs. SB	Iodixanol or low-osmolar	85	5

van Mourik et al. [24]	74	Symptomatic aortic valve stenosis and impaired renal function who underwent pre-TAVI CTA	82.9	44.6	104.3	47.4		31.1		SC vs. SB	Iopromide	90	3	74	Symptomatic aortic valve stenosis and impaired renal function who underwent pre-TAVI CTA	82.9	44.6	104.3	47.4		31.1		SC vs SB	Iopromide	90	3

Saratzis et al. [25]	58	Elective EVAR for infrarenal AAA	75	89.7		65.5		13.8		SC vs. SB	Iomeprol	126	3	58	Elective EVAR for infrarenal AAA	75	89.7		65.5		13.8		SC vs SB	Iomeprol	126	3

Maioli et al. [18]	296	Elective coronary angiographic procedures	71	68.2	89.3		48	24.7		SC vs. HDy	Iodixanol	131	3	296	Elective coronary angiographic procedures	71	68.2	89.3		48	24.7		SC vs HDy	Iodixanol	131	3

Kooiman et al. [26]	333	CKD patients undergoing elective cardiovascular diagnostic or interventional contrast procedures	73	64.6		50.5		38.7	16.5	SC vs. SB	Not mentioned	113	3	333	CKD patients undergoing elective cardiovascular diagnostic or interventional contrast procedures	73	64.6		50.5		38.7	16.5	SC vs SB	Not mentioned	113	3

Valette et al. [12]	307	Critically ill patients with stable renal function who received intravascular CM	56.2	67.8	61.4			13.4	6.5	SC vs. SB	Low-osmolar	90	4	307	Critically ill patients with stable renal function who received intravascular CM	56.2	67.8	61.4			13.4	6.5	SC vs SB	Low-osmolar	90	4

Nijssen et al. [10]	660	High-risk patients with eGFR of 30–59 ml/min/1.73 m², undergoing an elective procedure requiring CM administration	72	61.7	118	47.4		32.6		Non vs. SC	Iopromide	90.5	3	660	High-risk patients with eGFR of 30–59 ml/min/1.73 m², undergoing an elective procedure requiring CM administration	72	61.7	118	47.4		32.6		Non vs SC	Iopromide	90.5	3

Alonso et al. [27]	93	Patients receiving CM during CRT devices implantation	66.5	65.3	110.5		28.5	37		SC vs. SB	Iodixanol	102	2	93	Patients receiving CM during CRT devices implantation	66.5	65.3	110.5		28.5	37		SC vs SB	Iodixanol	102	2

Usmiani et al. [28]	124	Coronary angiography/PCI with eGFR of less than 60 ml/min/1.73 m²	75	74	130.8	44	25	84		SC vs. RenalGuard	Iodixanol	156	3	124	Coronary angiography/PCI with eGFR of less than 60 ml/min/1.73 m²	75	74	130.8	44	25	84		SC vs RenalGuard	Iodixanol	156	3

Turedi et al. [29]	172	Contrast-enhanced CTPA on suspicion of PE with at least one risk factor for CIN	75.5	51.7	85.4					SC vs. SB	Water-soluble, nonionic, low-osmolar	<100	3	172	Contrast-enhanced CTPA on suspicion of PE with at least one risk factor for CIN	75.5	51.7	85.4					SC vs SB	Water-soluble, nonionic, low-osmolar	<100	3

Qian et al. [19]	264	CKD and CHF undergoing coronary procedures	63.5	74.6	151	37.5	39.5	47.3		SC vs. HDy	Iodixanol	166	5	264	CKD and CHF undergoing coronary procedures	63.5	74.6	151	37.5	39.5	47.3		SC vs HDy	Iodixanol	166	5

Solomon et al. [30]	391	Elective coronary or peripheral angiography with eGFR <45 ml/min/1.73 m²	72	57.5	169.3	32.8		59.1	35.5	SC vs. SB	Not mentioned	107	4	391	Elective coronary or peripheral angiography with eGFR <45 ml/min/1.73 m²	72	57.5	169.3	32.8		59.1	35.5	SC vs SB	Not mentioned	107	4

Martin-Moreno et al. [31]	130	Receiving CM for CT scan	57.5	64.3	79.6					Non vs SB	Not mentioned	120	3	130	Receiving CM for CT scan	57.5	64.3	79.6					Non vs SB	Not mentioned	120	3

Jurado-Román et al. [32]	408	STEMI undergoing primary PCI	63.1	73.4		89		22.5	14.7	Non vs. SC	Iso-osmolar nonionic	174	2	408	STEMI undergoing primary PCI	63.1	73.4		89		22.5	14.7	Non vs SC	Iso-osmolar nonionic	174	2

Barbanti et al. [13]	112	TAVR	81	40.2	87.1	51.5	54.6	25		SC vs. RenalGuard	Buckinghamshire	175	3	112	TAVR	81	40.2	87.1	51.5	54.6	25		SC vs RenalGuard	Buckinghamshire	175	3

Yeganehkhah et al. [33]	100	CAG	59.7	53	99.5		43.8	39		SC vs. SB	Iohexol	45.4	3	100	CAG	59.7	53	99.5		43.8	39		SC vs SB	Iohexol	45.4	3

Yang et al. [34]	320	Elective cardiovascular procedures including CAG or interventional treatment	59.2	53.1	70.2	93.1	55.1	20		SC + NAC vs. SB + NAC	Iopromide	125	3	320	Elective cardiovascular procedures including CAG or interventional treatment	59.2	53.1	70.2	93.1	55.1	20		SC + NAC vs SB + NAC	Iopromide	125	3

Yang et al. [34]	320	Elective cardiovascular procedures including CAG or interventional treatment	59.2	53.1	70.2	93.1	55.1	20		SC vs. SB	Iopromide	125	3	320	Elective cardiovascular procedures including CAG or interventional treatment	59.2	53.1	70.2	93.1	55.1	20		SC vs SB	Iopromide	125	3

Thayssen et al. [35]	362	STEMI undergoing primary PCI within 12 hours from the onset of chest pain	62.5	78.5	77	90.5	50	9.7		SC vs. SB	Iodixanol	140	5	362	STEMI undergoing primary PCI within 12 hours from the onset of chest pain	62.5	78.5	77	90.5	50	9.7		SC vs SB	Iodixanol	140	5

Nieto-Rios et al. [36]	220	Tomography scan using CM or angiography	60	57.7	115.8			37.3		SC vs. SB	Iohexol	100	3	220	Tomography scan using CM or angiography	60	57.7	115.8			37.3		SC vs SB	Iohexol	100	3

Manari et al. [37]	592	STEMI within 12 h from symptom onset referred for primary angioplasty	65	74.8	88.5	81	48	16.6	11.8	SC vs. SB	Iodixanol	198	3	592	STEMI within 12 h from symptom onset referred for primary angioplasty	65	74.8	88.5	81	48	16.6	11.8	SC vs SB	Iodixanol	198	3

Mahmoodi et al. [38]	350	Coronary interventions	64.48	51.4	103	64.8				SC vs. SB	Iohexol		2	350	Coronary interventions	64.48	51.4	103	64.8				SC vs SB	Iohexol		2

Luo et al. [39]	216	STEMI	67	65.7	77	77.6		25		Non vs. SC	Iopamiron	234.9	3	216	STEMI	67	65.7	77	77.6		25		Non vs SC	Iopamiron	234.9	3

Kooiman et al. [40]	548	CKD patients receiving CE-CT	72.1	60.4		50.4		26.8	16.4	SC vs. SB	Iomeprol	105	5	548	CKD patients receiving CE-CT	72.1	60.4		50.4		26.8	16.4	SC vs SB	Iomeprol	105	5

Kooiman et al. [41]	138	CKD patients receiving CTPA	70.5	50		49.2		16.7	8	Non vs. SB	Iopromide or iobitridol or iodixanol	74	5	138	CKD patients receiving CTPA	70.5	50		49.2		16.7	8	Non vs SB	Iopromide, or iobitridol, or iodixanol	74	5

Brar et al. [17]	396	Referred to the cardiac catheterization laboratory with eGFR ≤ 60 mL/min/1.73 m², and at least one of the following: DM, CHF, hypertension, or age older than 75 years	72	61.9	123.8	48		51.3	20.5	SC vs. HDy	Ioxilan	108	3	396	Referred to the cardiac catheterization laboratory with eGFR ≤ 60 mL/min/1.73 m², and at least one of the following: DM, CHF, hypertension, or age older than 75 years	72	61.9	123.8	48		51.3	20.5	SC vs HDy	Ioxilan	108	3

Akyuz et al. [42]	225	At least one of the high-risk factors for developing CI-AKI and undergoing CAG and/or PCI	63.4	68.9	79.6	84.5	47.5	60.9	7.6	Oral vs. SC	Not mentioned	108	2	225	At least one of the high-risk factors for developing CI-AKI and undergoing CAG and/or PCI	63.4	68.9	79.6	84.5	47.5	60.9	7.6	Oral vs SC	Not mentioned	108	2

Kristeller et al. [43]	92	Stage 3 or higher CKD who underwent cardiac surgery using CPB	72.5	57.6	119.1			44.6	34.8	SC vs SB	Not mentioned	79	5	92	Stage 3 or higher CKD who underwent cardiac surgery using CPB	72.5	57.6	119.1			44.6	34.8	SC vs SB	Not mentioned	79	5

Koc et al. [44]	195	DM patients	62	52.3	88.4			100		SC vs. SB	Not mentioned	90	4	195	DM patients	62	52.3	88.4			100		SC vs SB	Not mentioned	90	4

Gu et al. [45]	859	Coronary angiography or angioplasty	59	72.2	90.1	74.2		20.6	0.6	SC vs. SC + diuresis	Not mentioned	100	2	859	Coronary angiography or angioplasty	59	72.2	90.1	74.2		20.6	0.6	SC vs SC + diuresis	Not mentioned	100	2

Boucek et al. [46]	120	Diabetic patients with impaired renal function, undergoing intra-arterial or intravenous use of CM	65	75	165	44.1		100		SC vs. SB	Low-osmolar nonionic iodinated	110	5	120	Diabetic patients with impaired renal function, undergoing intra-arterial or intravenous use of CM	65	75	165	44.1		100		SC vs SB	Low-osmolar nonionic iodinated	110	5

Marenzi et al. [47]	170	CKD undergoing coronary procedures	73	78.2	154.7	39	51.5	36.4		SC vs. RenalGuard	Iomeprol	170	3	170	CKD undergoing coronary procedures	73	78.2	154.7	39	51.5	36.4		SC vs RenalGuard	Iomeprol	170	3

Kong et al. [48]	80	Definitive or suspected coronary artery disease	56.5	53.8	105			23.8		Oral vs. SC	Iopromide	152	3	80	Definitive or suspected coronary artery disease	56.5	53.8	105			23.8		Oral vs SC	Iopromide	152	3

Klima et al. [49]	258	Renal insufficiency undergoing intravascular contrast procedures	77	64	137	43.6		37	44	SC vs. SB	Not mentioned	100	5	258	Renal insufficiency undergoing intravascular contrast procedures	77	64	137	43.6		37	44	SC vs SB	Not mentioned	100	5

Gomes et al. [50]	301	Patients at moderate to high risk for developing CIN who were referred for elective CAG or PCI	64	47.5	132.6			18.9		SC vs. SB	Not mentioned	125	2	301	Patients at moderate to high risk for developing CIN who were referred for elective CAG or PCI	64	47.5	132.6			18.9		SC vs SB	Not mentioned	125	2

Motohiro et al. [51]	155	eGFR <60 ml/min/1.73 m² who were undergoing coronary angiography	72.5	69.7	136.6	44.3	55	60		SC vs. SB	Iopamidol	135	3	155	eGFR <60 ml/min/1.73 m² who were undergoing coronary angiography	72.5	69.7	136.6	44.3	55	60		SC vs SB	Iopamidol	135	3

Maioli et al. [52]	300	STEMI undergoing primary PCI	65	25	95.9		42.5	21.7	24	Non vs. SB	Iodixanol	216	3	300	STEMI undergoing primary PCI	65	25	95.9		42.5	21.7	24	Non vs SB	Iodixanol	216	3

Lee et al. [53]	382	Diabetic patients with renal disease (serum creatinine >1.1 mg/dl and eGFR <60 ml/min/1.73 m²)	68	70.9	132.6	46		100		SC vs. SB	Iodixanol	116.5	3	382	Diabetic patients with renal disease (serum creatinine >1.1 mg/dl and eGFR <60 ml/min/1.73 m²)	68	70.9	132.6	46		100		SC vs SB	Iodixanol	116.5	3

Hafiz et al. [54]	320	Patients with baseline renal insufficiency scheduled to undergo catheterization	73	56.9	141.4			47.2		SC vs. SB	Nonionic, low-osmolar	115	3	320	Patients with baseline renal insufficiency scheduled to undergo catheterization	73	56.9	141.4			47.2		SC vs SB	Nonionic, low-osmolar	115	3

Briguori et al. [55]	292	High-risk patients with an eGFR ≤30 ml/min/1.73 m² and/or a risk score ≥11	76	65.4	158.7	32	47	70.2	28.4	SB vs. RenalGuard	Iodixanol	140	3	292	High-risk patients with an eGFR ≤30 ml/min/1.73 m² and/or a risk score ≥11	76	65.4	158.7	32	47	70.2	28.4	SB vs RenalGuard	Iodixanol	140	3

Wróbel et al. [56]	102	Coronary angiography and/or angioplasty, and had comorbidities that increase the risk of CIN	65.5	56.9	236.4					Oral vs. SC	Loversol	69.5	2	102	Coronary angiography and/or angioplasty, and had comorbidities that increase the risk of CIN	65.5	56.9	236.4					Oral vs SC	Loversol	69.5	2

Vasheghani-Farahani et al. [57]	72	CAG, with SCr 1.5 mg/dL within 2 weeks, having at least 1 of the risk factors	62	79.2	151.2	44.2	36.1	34.7	45.8	0.45 SC vs. SB	Iohexol	117.5	3	72	CAG, with SCr 1.5 mg/dL within 2 weeks, having at least 1 of the risk factors	62	79.2	151.2	44.2	36.1	34.7	45.8	0.45 SC vs SB	Iohexol	117.5	3

Cho et al. [58]	91	Undergoing an elective CAG	78	50.5	123			38.5	17.6	SC vs. SB	Isoversol	128	2	91	Undergoing an elective CAG	78	50.5	123			38.5	17.6	SC vs SB	Isoversol	128	2

Vasheghani-Farahani et al. [59]	265	Serum creatinine level of 1.5 mg/dL or greater undergoing elective CAG	63.3	83	145.4	45.9	51.7	21.5		SC vs. SB	Iohexol	114	5	265	Serum creatinine level of 1.5 mg/dL or greater undergoing elective CAG	63.3	83	145.4	45.9	51.7	21.5		SC vs SB	Iohexol	114	5

Tamura et al. [60]	144	Scheduled for elective CAG or PCI	72.8	87.5	121.1	39.1	57.8	58.3		SC vs. SB	Iohexol	85	3	144	Scheduled for elective CAG or PCI	72.8	87.5	121.1	39.1	57.8	58.3		SC vs SB	Iohexol	85	3

Pakfetrat et al. [61]	192	Undergoing elective CAG or PCI	57.9	61.5	97.2	72.2	50.5	29.7	5.2	SC vs. SB	Iodixanol	65	4	192	Undergoing elective CAG or PCI	57.9	61.5	97.2	72.2	50.5	29.7	5.2	SC vs SB	Iodixanol	65	4

Haase et al. [62]	100	At increased risk of postoperative acute renal dysfunction who were scheduled for elective or urgent cardiac surgery necessitating the use of CPB	71	66	90.7					SC vs. SB	Not mentioned		5	100	At increased risk of postoperative acute renal dysfunction who were scheduled for elective or urgent cardiac surgery necessitating the use of CPB	71	66	90.7					SC vs SB	Not mentioned		5

Budhiraja et al. [63]	187	Nonemergent CAG, baseline serum creatinine >1.0 mg/dL, and availability of serum creatinine values at days 1–3	68		125.8	57.2		30.5		SC vs. SB	Iopromide	199	2	187	Nonemergent CAG, baseline serum creatinine >1.0 mg/dL, and availability of serum creatinine values at days 1–3	68		125.8	57.2		30.5		SC vs SB	Iopromide	199	2

Angoulvant et al. [64]	201	Scheduled for elective CAG, with or without PTCA with a baseline SCr < 140 μmol/L	62	80.6	86.2					Oral vs. SC	Not mentioned	290	3	201	Scheduled for elective CAG, with or without PTCA with a baseline SCr< 140 μmol/L	62	80.6	86.2					Oral vs SC	Not mentioned	290	3

Maioli et al. [65]	502	Undergoing coronary angiographic procedures with estimated creatinine clearance <60 ml/min	74	59	107		46.5	59.1		SC vs. SB	Iodixanol	165	3	502	Undergoing coronary angiographic procedures with estimated creatinine clearance <60 ml/min	74	59	107		46.5	59.1		SC vs SB	Iodixanol	165	3

Chen et al. [66]	660	Myocardial ischemia (angina or positive exercise treadmill) scheduled for PCI, with SCr<1.5 mg/dl	60	85	114.9		54	8		Non vs. SC	Iso-osmolar nonionic	285	2	660	Myocardial ischemia (angina or positive exercise treadmill) scheduled for PCI, with SCr < 1.5 mg/dl	60	85	114.9		54	8		Non vs SC	Iso-osmolar nonionic	285	2

Chen et al. [66]	276	Myocardial ischemia (angina or positive exercise treadmill) scheduled for PCI, with SCr ≥ 1.5 mg/dl	63	82	221		41	22		Non vs. SC	Iso-osmolar nonionic	298	2	276	Myocardial ischemia (angina or positive exercise treadmill) scheduled for PCI, with SCr ≥ 1.5 mg/dl	63	82	221		41	22		Non vs SC	Iso-osmolar nonionic	298	2

Brar et al. [67]	353	Patients with stable renal disease and undergoing CAG	71	63.9	131.7	48	57	44.5	27.2	SC vs. SB	Ioxilan	132	5	353	Patients with stable renal disease and undergoing CAG	71	63.9	131.7	48	57	44.5	27.2	SC vs SB	Ioxilan	132	5

Adolph et al. [68]	145	Stable renal insufficiency and undergoing elective diagnostic or interventional coronary angiography	72.6	77.9	132.6			33.8		SC vs. SB	Iodixanol	140	5	145	Stable renal insufficiency and undergoing elective diagnostic or interventional coronary angiography	72.6	77.9	132.6			33.8		SC vs SB	Iodixanol	140	5

Schmidt et al. [69]	96	CAG	67.6	74	146.7			64.6		SC vs. SB	Optiray	186	2	96	CAG	67.6	74	146.7			64.6		SC vs SB	Optiray	186	2

Ozcan et al. [70]	264	Scheduled for CAG or PCI and had a baseline creatinine level >1.2 mg/dL	69	74.6	122.9			45.1	26.5	SC vs. SB	Ioxaglate	110	2	264	Scheduled for CAG or PCI and had a baseline creatinine level >1.2 mg/dL	69	74.6	122.9			45.1	26.5	SC vs SB	Ioxaglate	110	2

Masuda et al. [71]	59	Scheduled to undergo an emergency coronary angiography or intervention	75	44.1	116.2			30.5		SC vs. SB	Iopamidol	116	3	59	Scheduled to undergo an emergency coronary angiography or intervention	75	44.1	116.2			30.5		SC vs SB	Iopamidol	116	3

Dussol et al. [72]	156	CKD, who were undergoing radiological procedures with CM	65	67.9	204.5	33.1		28.8	16	SC vs. SC + diuresis	Nonionic, low osmolar	117	5	156	CKD, who were undergoing radiological procedures with CM	65	67.9	204.5	33.1		28.8	16	SC vs SC + diuresis	Nonionic, low osmolar	117	5

Mueller et al. [73]	425	Scheduled for elective or emergency PCI	64	75		89		16		0.45 SC vs. SC	Iopromide	226	2	425	Scheduled for elective or emergency PCI	64	75		89		16		0.45 SC vs SC	Iopromide	226	2

Merten et al. [74]	119	Stable renal insufficiency undergoing diagnostic or interventional procedures requiring radiographic contrast, SCr> 1.1 mg/dL	68	74.8	159.1			47.9		SC vs. SB	Iopamidol	132	3	119	Stable renal insufficiency undergoing diagnostic or interventional procedures requiring radiographic contrast, SCr> 1.1 mg/dL	68	74.8	159.1			47.9		SC vs SB	Iopamidol	132	3

Trivedi et al. [75]	53	Scheduled to undergo nonemergency CAG	67.9	98.1	106.4		52.1	18.9		Oral vs. SC	Ionic, low-osmolar	148	2	53	Scheduled to undergo nonemergency CAG	67.9	98.1	106.4		52.1	18.9		Oral vs SC	Ionic, low-osmolar	148	2

Mueller et al. [76]	1383	Scheduled for elective or emergency CAG	64	74.4	81.77			15.7		0.45 SC vs. SC	Ultravist or imeron	234	2	1383	Scheduled for elective or emergency CAG	64	74.4	81.77			15.7		0.45 SC vs SC	Ultravist, or imeron	234	2

CI-AKI: contrast-induced acute kidney injury; SCr: serum creatinine; eGFR: estimated glomerular filtration rate; LVEF: left ventricular ejection fraction; DM: diabetes mellitus; HF: heart failure; CM: contrast media; CTA: computed tomography angiography; TAVI: transcatheter aortic valve implantation; EVAR: elective endovascular aneurysm repair; AAA: abdominal aortic aneurysm; CKD: chronic kidney disease; CRT: cardiac resynchronization therapy; CTPA: computed tomography pulmonary angiography; PE: pulmonary embolism; CIN: contrast-induced nephropathy; CHF: chronic heart failure; CT: computed tomography; TAVR: transcatheter aortic valve replacement; CAG: coronary angiography; CE-CT: contrast media-enhanced computed tomography; CPB: cardiopulmonary bypass; PTCA: percutaneous transluminal coronary angioplasty; NAC: N-acetylcysteine. Treatment groups: SC: intravenous 0.9% sodium chloride; SB: intravenous sodium bicarbonate; Non: nonhydration; Oral: oral hydration; RenalGuard: RenalGuard system; HDy: hemodynamic guided hydration; SC + diuresis: intravenous 0.9% sodium chloride + diuresis; 0.45 SC: 0.45% sodium chloride.