We recommend using isotonic solutions such as physiological saline and sodium bicarbonate solution intravenously before and after contrast-enhanced examination in patients with CKD and a high risk for developing CIN.   2. We recommend using isotonic solutions to prevent CIN because isotonic 0.9 % sodium chloride injection (physiological saline) is superior to hypotonic 0.45 %

sodium chloride injection in preventing CIN.   In the 1980s, Eisenberg et al. [101, 102] demonstrated that the development of CIN in patients Selleck Autophagy Compound Library with CKD PCI-34051 order undergoing contrast-enhanced examination may be prevented by intravenous administration of physiological saline during the examination. Trivedi et al. [103] conducted a RCT to assess the role of saline hydration on the development of CIN. A total of 53 patients with normal kidney function who were going to undergo nonemergency cardiac catheterization were randomized to a group of patients receiving normal saline intravenously or a group of patients allowed unrestricted oral fluids. CIN (defined as an increase in SCr levels of ≥0.5 mg/dL within 48 h of contrast exposure) developed in 1 of the 27 patients (3.7 %) receiving saline infusion and 9 of the 26 patients (34.6 %) with unrestricted oral fluids (p = 0.005), indicating

that saline hydration significantly decreases the incidence of CIN. In the RENO Study, 111 patients Crenolanib ic50 with acute coronary syndrome undergoing emergency PCI were randomly assigned to receive an initial intravenous bolus of 5 mL/kg/h of alkaline saline

solution with 154 mEq/L of sodium bicarbonate over 1 h before PCI (group A) or to receive standard hydration after PCI (group B) [104]. The incidence of CIN was 1.8 % in group A and 21.8 % in group B (p = 0.032). It is recommended, according to these findings, that patients receive intravenous solutions such as physiological saline prior to contrast exposure to prevent CIN. In a RCT comparing the effects of isotonic and hypotonic fluids on the incidence of CIN, the isotonic solution (0.9 % physiological saline) was superior Branched chain aminotransferase to the hypotonic solution (0.45 % sodium chloride) [105]. In this study, 1,620 patients scheduled for selective or emergency coronary angioplasty were randomly assigned to receive isotonic (n = 809) or hypotonic (n = 811) hydration prior to intervention. The incidence of CIN (defined as an increase in SCr levels of ≥0.5 mg/dL within 48 h) was significantly reduced with isotonic (0.7 %, 95 % CI 0.1–1.4 %) vs. hypotonic (2.0 %, 95 % CI 1.0–3.1 %) hydration (p = 0.04). Many patients had normal kidney function at baseline, and non-ionic low-osmolar contrast media were used. Because the earlier-mentioned findings support the efficacy of isotonic fluids, such as physiological saline, in the prevention of CIN, we recommend the use of isotonic fluids as a preventive measure for CIN.