Table 3

Randomized controlled trials with fenoldopam, sodium bicarbonate, and haemodialysis/haemofiltration as prophylactic measures to prevent contrast-induced nephropathy

Reference

Year

Number of patients

Reason for contrast administration

Study design

Dose/timing/route of drug administration

Hydration regimen

Main outcome^a

Clinical trials with fenoldopam

[23]

2002

123

Cardiovascular procedures

RCT: hydration plus NAC po versus hydration alone versus hydration plus fenoldopam

Fenoldopam: 0.1 μg/kg per min, 4 hours before – 4 hours after contrast NAC 2 × 600 mg

1 ml/kg per hour 0.45% NaCl iv 12 hours before – 12 hours after contrast

18% in the NAC group versus 15% in the NaCl group (P = NS; RR 1.18, 95% CI 0.45–3.12)

[48]

2002

45

Cardiovascular procedures

RCT: hydration versus hydration plus fenoldopam

Fenoldopam at 0.1 μg/kg per min, >1 hour before contrast

100 ml/hour 0.45% NaCl iv, 3 hours before – 4 hours after contrast

41% in the saline group versus 21% in the fenoldopam group(P = 0.148); diabetes patients 64% versus 33% (P = 0.14)

[49]

2003

315

Angiography

RCT: fenoldopam

Fenoldopam 0.05 μg/kg per min titrated to 0.10 μg/kg per min, 30 min before – 12 hours after contrast

1.5 ml/kg per hour 0.45% NaCl iv 2–12 hours before – 12 hours after contrast

34% in fenoldopam group versus 30% in the placebo group (P = 0.61; RR 1.11, 95% CI 0.79–1.57)

Clinical trials with sodium bicarbonate

[37]

2004

119

Various reasons

RCT: saline versus sodium bicarbonate before and after contrast administration

3 ml/kg per hour 154 mEq/l sodium bicarbonate 1 hour pre-procedure + 1 ml/kg per hour154 mEq/l sodium bicarbonate 6 hours post-procedure

The control group received a similar infusion, but with 154 mEq/l NaCl

14% in saline patients versus 2% in patients receiving sodium bicarbonate (P = 0.02; 95% CI 0.03–0.21)

Clinical trials with haemodialysis/haemofiltration

[50]

2001

113

Various reasons

RCT: haemodialysis versus nonhaemodialysis treatment after injection of contrast

Directly after contrast exposure

1 ml/kg per hour 0.45% NaCl iv 12 hours before – 12 hours after contrast

No significant differences

[52]

2003

114

Coronary angioplasty

RCT: haemofiltration (in an intensive care unit) versus hydration (in a step-down unit)

4–8 hours before to 18–24 hours after procedure

1 ml/kg per hour 0.45% NaCl iv 12 hours before – 12 hours after contrast

5% versus 50% (P < 0.001)

[53]

2003

17

Angiography

RCT: 4-hour online dialysis during contrast injection versus standard therapy

Haemodialysis simultaneously with contrast administration

2000 ml 0.9% NaCl 6 hours before – 6 hours after contrast

No significant differences

^aIncidences of contrast-induced nephropathy. CI, confidence interval; iv, intravenously; NAC, N-acetylcysteine; po, by mouth; RCT, randomized controlled trial; RR, relative risk.

van den Berk et al. Critical Care 2005 9:361   doi:10.1186/cc3028