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 outcomea |
|---|---|---|---|---|---|---|---|
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 |