Prevention of contrast media-associated nephropathy: randomized comparison of 2 hydration regimens in 1620 patients undergoing coronary angioplasty

Arch Intern Med. 2002 Feb 11;162(3):329-36. doi: 10.1001/archinte.162.3.329.


Background: The administration of radiographic contrast agents remains an important cause of acute renal failure. The optimal infusion for hydration has not been evaluated.

Objective: To compare the incidence of contrast media-associated nephrotoxicity with isotonic or half-isotonic hydration.

Design: Prospective, randomized, controlled, open-label study.

Methods: Patients scheduled for elective or emergency coronary angioplasty were randomly assigned to receive isotonic (0.9% saline) or half-isotonic (0.45% sodium chloride plus 5% glucose) hydration beginning the morning of the procedure for elective interventions and immediately before emergency interventions. An increase in serum creatinine of at least 0.5 mg/dL (44 micromol/L) within 48 hours was defined as contrast media-associated nephrotoxicity. Secondary end points were cardiac and peripheral vascular complications.

Results: A total of 1620 patients were assigned to receive isotonic (n = 809) or half-isotonic (n = 811) hydration. Primary end point analysis was possible in 1383 patients. Baseline characteristics were well matched. Contrast media-associated nephropathy was significantly reduced with isotonic (0.7%, 95% confidence interval, 0.1%-1.4%) vs half-isotonic (2.0%, 95% confidence interval, 1.0%-3.1%) hydration (P =.04). Three predefined subgroups benefited in particular from isotonic hydration: women, persons with diabetes, and patients receiving 250 mL or more of contrast. The incidence of cardiac (isotonic, 5.3% vs half-isotonic, 6.4%; P =.59) and peripheral vascular (isotonic, 1.6% vs half-isotonic, 1.5%, P =.93) complications was similar between the 2 hydration groups.

Conclusion: Isotonic hydration is superior to half-isotonic hydration in the prevention of contrast media-associated nephropathy.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Acute Kidney Injury / etiology
  • Acute Kidney Injury / prevention & control*
  • Aged
  • Analysis of Variance
  • Angioplasty / adverse effects*
  • Angioplasty / methods
  • Confidence Intervals
  • Contrast Media / adverse effects
  • Coronary Angiography / adverse effects*
  • Coronary Angiography / methods
  • Extravasation of Diagnostic and Therapeutic Materials / complications*
  • Female
  • Fluid Therapy / methods*
  • Humans
  • Kidney Function Tests
  • Logistic Models
  • Male
  • Middle Aged
  • Preoperative Care
  • Probability
  • Prognosis
  • Prospective Studies
  • Saline Solution, Hypertonic / administration & dosage
  • Sensitivity and Specificity
  • Sodium Chloride / administration & dosage
  • Treatment Outcome


  • Contrast Media
  • Saline Solution, Hypertonic
  • Sodium Chloride