Background: Postcontrast acute kidney injury (PC-AKI) is known to have a mild, often self-limiting, clinical course. Despite this, preventative measures are advised by international guidelines in high-risk patients.
Study design: The Kompas trial was a multicenter, open-label, noninferiority randomized clinical trial in which 523 patients with stage 3 CKD were randomized to receive no hydration or prehydration with 250 mL of 1.4% sodium bicarbonate in a 1-hour infusion before undergoing elective contrast-enhanced CT. The primary endpoint was the mean relative increase in serum creatinine 2-5 days after contrast administration, compared with baseline.
Setting: Six hospitals in the Netherlands during April 2013–September 2016.
Synopsis: Of the 523 patients, (median age, 74 years), the mean relative increase in creatinine level 2-5 days after contrast administration compared with baseline was 3.0% in the no-prehydration group vs. 3.5% in the prehydration group. This demonstrates that withholding prehydration is noninferior to administrating prehydration. PC-AKI occurred in 7 of 262 patients in the no-prehydration group and 4 of 261 patients in the prehydration group and no patients required dialysis or developed heart failure. These results reassure us that prehydration with sodium bicarbonate can be safely omitted in patients with stage 3 CKD who undergo contrast-enhanced CT.
Bottom line: Prehydration with sodium bicarbonate is not needed to prevent additional renal injury in patients with CKD stage 3 undergoing contrast-enhanced CT imaging.
Citation: Timal RJ et al. Effect of no prehydration vs sodium bicarbonate prehydration prior to contrast-enhanced computed tomography in the prevention of postcontrast acute kidney injury in adults with chronic kidney disease: The Kompas Randomized Clinical Trial. JAMA Intern Med. 2020 Feb 17. doi: 10.1001/jamainternmed.2019.7428.
Dr. Moulder is assistant professor of medicine, section of hospital medicine, at the University of Virginia School of Medicine, Charlottesville.