Een requiem voor prehydratie bij CT-onderzoek?

Commentaar
29-07-2020
Michiel G.H. Betjes

Elders in het NTvG worden de resultaten van de Kompas-studie beschreven. In deze trial werd het effect van prehydratie met natriumbicarbonaat voorafgaand aan CT-onderzoek onderzocht. De onderzoekers concluderen dat prehydratie ter preventie van acute nierschade bij patiënten met chronische nierschade in stadium 3 geen meerwaarde heeft.

A requiem for prehydration in CT imaging?

A recently published randomised controlled trial (the Kompas trial) compared prehydration with sodium bicarbonate solution with no prehydration in patients with chronic kidney disease (eGFR 30-60 ml/min per 1.73 m2) undergoing elective CT scanning with intravenous contrast agent. Although patients were considered to be at risk for postcontrast acute kidney injury (PC-AKI), average serum creatinine concentration increased by 2% after 5-7 days with no serious persistent decline in renal function. No significant differences were found between treatment and no treatment arms of the study. Results are in agreement with previous trials and confirm that risk of clinically relevant PC-AKI is very low and that prehydration is not warranted in this group of patients. Patients with an eGFR of less than 30 ml/min per 1.73 m2 and multiple AKI risk factors have a higher risk of PCI-AKI and may benefit from prehydration, although the risk-benefit balance remains unclear.

Conflict of interest and financial support: no conflicts of interest have been reported.

Belangenconflict en financiële ondersteuning: er zijn geen belangen gemeld.