April 9, 2020

Background: Most guidelines recommend prehydration prior to iodine-based contrast media to prevent postcontrast acute kidney injury (PC-AKI) in patients with CKD.  There is, however, a lack of evidence for the effectiveness of this as well as the potential adverse effects from the hydration itself (i.e. congestive heart failure exacerbation). We have covered the AMACING trial on REBEL EM which was a randomized clinical trial evaluating prehydration with 0.9% normal saline vs no prehydration in patients with estimated glomerlular filtration rates of 30 – 59mL/min/1.73m2.  In that study there was no difference in their primary outcome of contrast induced nephropathy (now called postcontrast acute kidney injury - PC-AKI) at 2 – 6 days after IV contrast (2.7% with prehydration vs 2.6% without prehydration). The trial we are are covering today, the Kompas trial, directly compared prehydration with sodium bicarbonate vs no prehydration prior to non-emergent intravenous contrast-enhanced CT in patients with CKD stage 3.