Kennisvragen

De werkgroep meent dat (vervolg)onderzoek wenselijk is om in de toekomst een duidelijker antwoord te kunnen geven op vragen uit de praktijk. 

Kennisvraag 1

Welke hydratiestrategie dient te worden toegepast bij patiënten met een eGFR <30ml/min/1.73m² die intravasculair jodiumhoudend contrastmiddel (CM)-toediening ondergaan?

Toelichting 1:

In clinical practice, and in agreement with the current guideline, hydration strategies to prevent PC-AKI are only applied in patients with an eGFR <30ml/min/1,73m². However, studies focusing on this population are lacking. The field would benefit from an RCT comparing the different hydration strategies to each other and to no hydration in this group specifically, including a control group without CM administration. This has been tried in the USA, but the cost was high, and inclusion was so difficult that the trial was stopped early. So, an RCT will probably never materialize.

Individualizing hydration for eGFR < 30 is probably more practical. 

Kennisvraag 2

Is er een significant verschil in de incidentie van PC-AKI bij intraveneuze prehydratie (alleen) versus pre- en posthydratie (gecombineerd)?

Toelichting 2:

Thus far, no studies comparing pre vs. pre/posthydration with bicarbonate 1.4% or NaCl 0.9% have been performed. More data in which only the timing of hydration is studied, could be beneficial, with a control group without CM administration. In separate trials for intravenous CM / intra-arterial CM with second pass renal exposure and for intra-arterial CM with first pass renal exposure. 

Kennisvraag 3

Welke hydratiestrategie dient te worden toegepast bij patiënten die intravasculair jodiumhoudend contrastmiddel (CM)-toediening ondergaan met first-pass renale blootstelling? Met specifieke aandacht voor klinische context en eGFR-status.

Toelichting 3:
In clinical practice, and in agreement with the current guideline, hydration strategies to prevent PC-AKI in patients receiving intra-arterial CM with first pass renal exposure are only applied in patients with an eGFR <30ml/min/1,73m². However, studies focusing on this population are lacking. Furthermore, in writing current guideline recommendations, a lack of clinically relevant subgroup analysis is apparent in current available literature with identified studies limited to cardiac diagnostics or interventions including a relatively large number of patients in the eGFR 45 – 60 ml/min/1.73m² range. Future research on the incidence of PC-AKI for patients with an eGFR < 30, eGFR 30 – 45 and eGFR 45 – 60 ml/min/1.73m² for elective interventional cardiological diagnostics and procedures, non-elective interventional cardiological procedures as well as elective and non-elective body procedures with first-pass renal exposure is required. As well as future research on cost-effective PC-AKI prevention strategies for patient groups with observed elevated PC-AKI risk.