Efficacy and Safety of a Balanced Salt Solution Versus a 0.9% Saline Infusion for the Prevention of Contrast-Induced Acute Kidney Injury After Contrast-Enhanced Computed Tomography

Abstract Rationale & Objective We aimed to elucidate whether a balanced salt solution decreases the occurrence of contrast-induced acute kidney injury (CI-AKI) after contrast-enhanced computed tomography (CE-CT) as compared to a 0.9% saline. Study design A randomized clinical trial Setting and participants The study was performed in 14 tertiary hospitals in South Korea. Patients with estimated glomerular filtration rate (eGFR) Intervention An open-label intervention was performed. The study group received a balanced salt solution and the control group a 0.9% saline as prophylactic fluids for CE-CT scans. Outcomes The primary outcome was CI-AKI, defined by creatinine elevation of ≥ 0.5 mg/dL or 25% from baseline within 48-72 hours after CE-CT. The secondary outcomes included AKI defined based on the KDIGO guidelines, eGFR changes, death, or requiring dialysis within 6 months after CE-CT. Results A total of 493 patients received the study fluids. The control and study groups included 251 and 242 patients, respectively. The occurrence of CI-AKI in the study [10 (4.2%)] and control [17 (6.8%)] groups was not significantly different (P = 0.27). No significant difference was present for the secondary outcomes; AKI by the KDIGO definition [study: 19 (7.9%), control: 27 (10.8%), P=0.33], death/dialysis [study: 11 (4.7%), control: 9 (3.7%), P=0.74], and eGFR changes [study: 0.1±0.2 mg/dL, control: 0.3±2.8 mg/dL, P=0.69]. Limitations This study failed to meet target enrollment. Conclusion The risk of CI-AKI was similar after the administration of a balanced salt solution and after the use of a 0.9% saline during CE-CT scans in higher-risk patients.