Meta-analysis of prophylactic hydration versus no hydration on contrast-induced acute kidney injury

Background Guidelines recommend prophylactic hydration for all patients with compromised renal function undergoing contrast exposure. However, the AMACING study published recently showed a noninferior result of hydration compared with no prophylaxis in high-risk patients and led to a heat discussion. This study aimed to validate the effectiveness of prophylactic hydration in different subsets of patients undergoing a contrast procedure. Methods We carried out a meta-analysis of randomizedcontrolled trials to assess pooled estimates of relative risk (RR) and 95% confidence intervals (CIs) for incidences of contrast-induced acute kidney injury (CI-AKI), in-hospital all-cause mortality, and need for dialysis. Results Compared with no prophylaxis, patients receiving prophylactic hydration had a lower risk of CI-AKI [RR: 0.66 (95% CI: 0.55-0.79); P = 0.001; P-heterogeneity = 0.42] and a lower risk of deaths of all-cause [RR: 0.57 (95% CI: 0.33-0.98); P = 0.04; P-heterogeneity = 0.47], but did not have a decreased risk of need for dialysis [RR: 0.39 (95% CI: 0.12-1.23); P = 0.11; P-heterogeneity= 0.31]. In subgroup analyses on the incidence of CI-AKI by baseline estimated glomerular filtration rate (eGFR), no benefit from prophylactic hydration was indicated in patients with a baseline eGFR ranging from 30 to 60 ml/min/1.73m(2) [RR: 1.02 (95% CI: 0.66-1.60); P-heterogeneity = 0.66; P-interaction = 0.03]. Conclusion Our analysis indicated that prophylactic hydration was associated with a lower risk of CI-AKI and all-cause deaths, but not with the need for dialysis in the overall population. However, no prophylactic hydration is noninferior to intravenous hydration on the incidence of CI-AKI in patients with a baseline eGFR ranging from 30 to 60 ml/min/1.73m(2). Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.