Isotonic saline hydration cuts contrast media-associated nephropathy

By David Douglas

NEW YORK (Reuters Health) – Hydration with normal saline, rather than saline and glucose, more than halves the incidence of contrast media-associated nephropathy following diagnostic angiography, according to European researchers.

In fact, lead author Dr. Christian Mueller told Reuters Health that "the incidence of contrast media-associated nephropathy is very low in patients undergoing coronary angioplasty if appropriate hydration is used." However, "normal saline seems to be superior to half-normal saline."

In February 11th issue of the Archives of Internal Medicine, Dr. Mueller, of University Hospital, Basel, Switzerland, and colleagues note that although radiographic contrast agents are an important cause of acute renal failure, "the optimal infusion for hydration has not been evaluated."

To investigate, the researchers studied 1383 patients scheduled for coronary angioplasty. They were randomly assigned to receive isotonic (0.9% sodium chloride) saline or half-isotonic (0.45% sodium chloride and 5% glucose) saline for hydration.

The incidence of cardiac and peripheral vascular complications was similar between groups, but contrast media-associated nephropathy was significantly reduced in the normal saline group.

The incidence was 0.7% in those given isotonic saline compared to 2% in those who received half-isotonic saline. Differences were particularly noticeable in women, patients with diabetes, and those given 250 mL or more of contrast media.

"As prevention of disease should always have top priority," Dr. Mueller concluded, "our data suggest that intravenous hydration should be used in all patients undergoing contrast studies, and normal saline seems to be the infusion of choice."

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