No prophylaxis is non-inferior and cost-saving to prophylactic intravenous hydration in preventing contrast-induced nephropathy on requiring iodinated contrast material administration

In the 1980s, Eisenberg et al. demonstrated that the development of contrast-induced nephropathy (CIN) in patients with chronic kidney disease (CKD) undergoing contrast-enhanced examination may be prevented by intravenous administration of physiological saline during the examination (1,2). Trivedi et al. conducted a randomized prospective trial to assess the role of saline hydration on the development of CIN (3). A total of 53 patients with normal renal function who were going to undergo nonemergency cardiac catheterization were randomized to a group of patients receiving normal saline intravenously or a group of patients allowed unrestricted oral fluids. CIN developed in 1 of the 27 patients (3.7%) receiving saline infusion and 9 of the 26 patients (34.6%) with unrestricted oral fluids (P=0.005), indicating that saline hydration significantly decreases the incidence of CIN. According to these findings, it is recommended that patients receive intravenous solutions such as physiological saline prior to contrast exposure to prevent CIN. However, clinical-effectiveness and cost-effectiveness of this prophylactic hydration treatment in protecting renal function has not been adequately studied in the population targeted by the guidelines, against a group receiving no prophylaxis.