The use of isotonic fluids to prevent CIN should be considered for patients with a GFR of <45 mL/min/1.73 m2

undergoing noninvasive contrast-enhanced examinations such as contrast-enhanced A 769662 CT after intravenous administration of contrast media, and for patients with a GFR of <60 mL/min/1.73 m2 undergoing invasive contrast-enhanced examinations such as CAG with intra-arterial administration of contrast media. Does oral water intake decrease the risk for developing CIN as much as administration of fluid therapy does? Answer: There is no sufficient evidence that oral water intake is as effective as intravenous fluid therapy in preventing the development of CIN. We consider that patients receive fluid therapy or other established preventive measures rather than rely on oral water intake to prevent CIN. It is difficult to conduct intravenous hydration as a measure to prevent CIN in outpatients or patients undergoing emergency imaging. For such patients, oral fluid loading has been tried to prevent dehydration and promote diuresis. Trivedi et al. [103] evaluated the effects of unrestricted oral fluids and intravenous saline hydration on the incidence of CIN in patients undergoing nonemergency cardiac catheterization, and reported that saline hydration was superior to oral fluids in terms of the prevention

SAHA HDAC in vitro of CIN and the severity of kidney dysfunction. In a study of the effects of oral hydration with mineral water versus intravenous hydration with isotonic solution on kidney function in patients with

diabetes undergoing elective CAG and PCI, 52 patients (group 1; mean CCr: 70.3 mL/min) were hydrated intravenously (1 mL/kg/h), during the 6 h before and during the 12 h after CABG or PCI, with isotonic solution (0.9 % NaCl) [106]. Fifty patients (group 2; Olopatadine mean CCr 79 mL/min) were randomized to receive oral water intake (1 mL/kg/h) during 6–12 h before and during the 12 h after CAG or PCI. At 72 h after the PS-341 in vitro procedure, the mean CCr was 65.3 mL/min in group 1 and 73.5 mL/min in group 2 (not significant [NS]). The incidence of CIN was 5.77 % in group 1 and 4.00 % in group 2 (NS). In the PREPARED study, 36 patients with CKD (SCr levels ≥1.4 mg/dL) undergoing elective cardiac catheterization were randomized to receive either an outpatient hydration protocol including precatheterization oral hydration (1,000 mL oral water intake over 10 h) followed by 6 h of intravenous hydration (0.45 % normal saline solution at 300 mL/h; n = 18) beginning just before contrast exposure, or overnight intravenous hydration (0.45 % normal saline solution at 75 mL/h for both 12 h precatheterization and postcatheterization procedures; n = 18) [107]. The maximal changes in SCr levels in the inpatient (0.21 ± 0.38 mg/dL) and outpatient (0.12 ± 0.23 mg/dL) groups were similar (NS). They concluded that an oral hydration strategy prior to PCI/CAG was similar to intravenous hydration in preventing contrast-associated changes in SCr levels.