In a RCT of 63 patients with CKD who received either 12-h intrave

In a RCT of 63 patients with CKD who received either 12-h intravenous hydration at 1 mL/kg/h or bolus hydration at a volume of 250 mL over 1 h immediately before procedure, the incidence of CIN was 0 % in patients receiving overnight hydration and 10.8 % in patients receiving bolus hydration [125]. Meanwhile, in a study comparing intravenous administration of ≥2,000 mL/day within

12 h before and after contrast exposure, and volume expansion with 300 mL learn more saline immediately before the administration of contrast media, the incidence of CIN did not differ between the groups [126]. Among 4 RCTs comparing 1-h sodium bicarbonate hydration at 3 mL/kg/h with 6–12 h saline hydration at 1 mL/kg/h, 3 RCTs did not show a difference in the incidence of CIN between the groups [121, 124, 127]. These findings suggest that short-term sodium bicarbonate-based hydration is as effective as standard saline find more hydration in preventing CIN. In 2 RCTs, patients received furosemide in addition to saline hydration to achieve a urine flow of ≥300 mL/h before contrast exposure and to maintain it for 4 h after contrast exposure to

prevent CIN in high-risk patients [20, 21]. In the REMEDIAL II study, 292 patients with CKD and a GFR of <30 mL/min/1.73 m2 were randomized to receive sodium bicarbonate solution and NAC (n = 146), or aggressive saline hydration, NAC, and furosemide (n = 146) [20]. In the group of patients receiving saline infusion and furosemide with keeping urine volume more than 300 mL/h, a 53 % RR reduction was observed as compared with that seen in patients receiving sodium bicarbonate-based hydration (OR 0.47, 95 % CI 0.24–0.92). In patients with a higher risk of heart failure, the initial bolus administration of saline was reduced to ≤150 mL. No patients experienced adverse drug reactions to furosemide, but acute pulmonary edema due to volume overload developed in 3 patients. According to these findings, administration of a large amount of saline and furosemide may be effective in the prevention of CIN

after contrast exposure in patients with a GFR of <30 mL/min/1.73 m2. However, Sorafenib purchase patients should be closely observed to prevent the occurrence of pulmonary edema. Only a few studies have investigated the efficacy of hydration within 1 h before contrast exposure as compared with intravenous hydration over 12 h, and no sufficient evidence has been obtained. Further studies should be done in this area. Prevention of contrast-induced nephropathy: pharmacologic therapy It has been suggested that renal injury due to reactive oxygen species, renal vascular constriction, and renal ischemia may play important roles in the development of CIN. Accordingly, vasodilating drugs and antioxidants have been expected to prevent or alleviate CIN, and many clinical studies of these drugs have been conducted. However, there have been no established pharmacological measures to prevent CIN.

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