A randomized controlled trial comparing hydration therapy to additional hemodialysis or N-acetylcysteine for the prevention of contrast medium-induced nephropathy: the Dialysis-versus-Diuresis (DVD) Trial

Clin Res Cardiol. 2007 Mar;96(3):130-9. doi: 10.1007/s00392-007-0473-4. Epub 2006 Dec 22.


Contrast medium-induced nephropathy (CIN) is a serious complication with increasing frequency and an unfavorable prognosis. Previous analyses of surrogate parameters have suggested beneficial effects of hemodialysis that are assessed in this randomized clinical trial. We performed a prospective single-center trial in 424 consecutive patients with serum creatinine concentrations between 1.3- 3.5 mg/dl who underwent elective coronary angiography. Patients were randomized to one of three treatment strategies with all patients receiving pre- and postprocedural hydration: One group received no additional therapy, patients in the second group were hemodialyzed once, and the third group received oral N-acetylcysteine. The frequency of CIN (defined as an increase in serum creatinine>or=0.5 mg/dl) from 48 to 72 h after catheterization was 6.1% in the hydration-only group, 15.9% with hemodialysis treatment, and 5.3% in the N-ACC group (intention-to-treat analysis; P=0.008). There were no differences between the treatment groups with regard to increased (>or=0.5 mg/dl) serum creatinine concentrations after 30-60 days (4.8%, 5.1%, and 3.1%, respectively; P=0.700). Analyses of long-term follow-up (range 63 to 1316 days) by Cox regressions models of the study groups found quite similar survival rates (P=0.500). In contrast to other (retrospective) studies, long-term survival of patients with vs those without CIN within 72 h was not different, but patients who still had elevated creatinine concentrations at 30-60 days suffered from a markedly higher 2-year mortality (46% vs 17%, P=0.002). In conclusion, hemodialysis in addition to hydration therapy for the prevention of CIN provided no evidence for any outcome benefit but evidence for probable harm. Increased creatinine concentrations at 30-60 days, but not within 72 h, were associated with markedly reduced long-term survival.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acetylcysteine / administration & dosage
  • Acetylcysteine / therapeutic use*
  • Acute Kidney Injury / blood
  • Acute Kidney Injury / chemically induced
  • Acute Kidney Injury / mortality
  • Acute Kidney Injury / prevention & control*
  • Aged
  • Biomarkers / blood
  • Contrast Media / adverse effects*
  • Coronary Angiography / methods
  • Creatinine / blood
  • Diuresis
  • Diuretics / administration & dosage
  • Diuretics / therapeutic use
  • Female
  • Fluid Therapy* / methods
  • Follow-Up Studies
  • Free Radical Scavengers / administration & dosage
  • Free Radical Scavengers / therapeutic use*
  • Germany
  • Humans
  • Isotonic Solutions
  • Male
  • Middle Aged
  • Proportional Hazards Models
  • Prospective Studies
  • Renal Dialysis* / methods
  • Survival Analysis


  • Biomarkers
  • Contrast Media
  • Diuretics
  • Free Radical Scavengers
  • Isotonic Solutions
  • Creatinine
  • Acetylcysteine