van Mourik MS, et al. - Researchers investigated whether a short (1-hour, 3 ml/kg/h sodium bicarbonate) hydration protocol vs conventional (24-hour, 1 ml/kg/h saline) hydration is non-inferior in terms of avoiding a decline in renal function in patients with impaired renal function undergoing computed tomography angiography (CTA) before pre-transcatheter aortic valve implantation (TAVI). Findings demonstrated non-inferiority of a short 1-hour, low-volume hydration protocol with sodium bicarbonate vs conventional 24-hour, high-volume saline hydration for patients with impaired renal function undergoing pre-TAVI CTA.

Methods

• This single-center randomized non-inferiority trial was performed in patients with impaired renal function who underwent pre-TAVI CTA.
• Researchers randomized these patients, on a 1:1 ratio, to short hydration (SHORT; 1-hour sodium bicarbonate, 3 ml/kg/hour) or conventional hydration (CONV; 24-hour saline, 1 ml/kg/hour).
• They assessed percentage change in serum creatinine 2–6 days after CTA with a non-inferiority margin of 10% and an increase on the Borg dyspnea scale ≥ 1 point as outcomes.

Results

• This study included a total of 74 patients.
• In the SHORT and in the CONV arm, the observed increase in creatinine was 6 μmol/l (95% CI 2.5–9.3) and 2 μmol/l (95% CI-1.4 to 6.3), respectively (p=0.167).
• Compared to the SHORT arm, for which 4.6% (95% CI 2.0–7.3%) was the estimated percentage change, the CONV arm exhibited 2.5% (95% CI: 0.8 to 5.8%) change.
• Between the two arms, the estimated difference in percentage increase in creatinine was 2.1% (95% CI: 2.0–6.2%; p-value non-inferiority: <0.001).
• Findings did not report CI-AKI and a need for dialysis.
• They observed an increase of ≥ 1 point on the Borg scale (dyspnea scale ranging from 1 to 10) in 1 patient in the SHORT arm vs 5 patients in the CONV arm (2.9% vs 16.1%, p=0.091).