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Does the method of administering fluids matter for contrast-induced nephropathy? REMEDIAL III compares LVEDP versus

Cindy L Grines1, J Jeffrey Marshall1

  • 1Northside Cardiovascular Institute, Atlanta, Georgia, USA.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|April 16, 2020
PubMed

Insights

Contrast-induced nephropathy (CIN) is a significant risk for patients undergoing angiography. The REMEDIAL III trial investigates optimal hydration strategies to prevent CIN, comparing two targeted regimens in high-risk patients.

Area of Science:

  • Nephrology
  • Cardiology
  • Radiology

Background:

  • Contrast-induced nephropathy (CIN) is a serious complication following angiographic procedures, contributing to patient morbidity and mortality.
  • Current preventative strategies, including limiting contrast media and intravenous hydration, have limitations due to poorly understood optimal protocols.

Discussion:

  • The REMEDIAL III trial aims to optimize hydration protocols for CIN prevention.
  • This study will compare two distinct hydration regimens: one guided by continuous urine output monitoring and another by initial left ventricular end-diastolic pressure (LVEDP).

Key Insights:

  • Optimal hydration timing, dose, and duration remain critical unanswered questions in CIN prevention.
  • Targeted hydration strategies may offer a more effective approach to reducing CIN incidence.

Outlook:

  • The trial will randomize 700 high-risk patients to evaluate the efficacy of the two hydration regimens.
  • Findings from REMEDIAL III are expected to refine clinical guidelines for CIN prevention in patients undergoing angiography.

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