The place of hydration using intravenous fluid in patients at risk of developing contrast-associated nephropathy

There has been a significant rise in the incidence of contrast-associated nephropathy caused by administration of contrast media during cardiac interventions. This is one of the major complications of percutaneous coronary interventions, which may proceed to acute renal failure. Risk factors, including pre-existing renal dysfunction, older age and use of high osmolar contrast media, predispose patients to the development of contrast-associated nephropathy. Different risk-reduction strategies have been used to prevent contrast-associated nephropathy, including use of low osmolar contrast media, N-acetylcysteine, alkalisation of tubular fluid with intravenous sodium bicarbonate, and oral and intravenous hydration with isotonic solution. Hydration using intravenous saline is one of the main treatments used to prevent the development of nephropathy in patients receiving contrast media during cardiac interventions. Prehydration, before administering contrast media, seems to be crucial. The results of studies of the relative efficacy of sodium bicarbonate and/or N-acetylcysteine in reducing the development of contrast-associated nephropathy are not consistent and any beneficial effects may depend on the pre-existing state of the kidney. This review discusses hydration of patients who are at risk of developing contrast-associated nephropathy using intravenous fluid.

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Risk reduction strategies for patients at risk of medication-related osteonecrosis of the jaws undergoing dental extractions: a systematic review

10.37766/inplasy2021.6.0064 ◽

2021 ◽

Author(s):

Tina Halai ◽

Roberto Sacco ◽

Valeria Mercadante ◽

Josiah Eyeson ◽

Stefano Fedele

Keyword(s):

Systematic Review ◽

At Risk ◽

Risk Reduction ◽

Osteonecrosis Of The Jaws ◽

Reduction Strategies ◽

Patients At Risk ◽

Risk Reduction Strategies

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Are Referring Clinicians Aware of Patients at Risk from Intravenous Injection of Iodinated Contrast Media?

Clinical Radiology ◽

10.1053/crad.2001.0849 ◽

2002 ◽

Vol 57 (2) ◽

pp. 132-135 ◽

Cited By ~ 16

Author(s):

Eli Konen ◽

Osnat Konen ◽

Miriam Katz ◽

Yair Levy ◽

Judith Rozenman ◽

...

Keyword(s):

At Risk ◽

Contrast Media ◽

Intravenous Injection ◽

Iodinated Contrast Media ◽

Iodinated Contrast ◽

Patients At Risk

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Feasibility of a Pilot Randomized Controlled Trial Examining a Multidimensional Intervention in Women with Gynecological Cancer at Risk of Lymphedema

Current Oncology ◽

10.3390/curroncol28010048 ◽

2021 ◽

Vol 28 (1) ◽

pp. 455-470

Author(s):

Shirin M. Shallwani ◽

Anna Towers ◽

Anne Newman ◽

Shannon Salvador ◽

Angela Yung ◽

...

Keyword(s):

At Risk ◽

Risk Reduction ◽

Controlled Trial ◽

Gynecological Cancer ◽

Intervention Group ◽

Future Research ◽

Control Group ◽

Randomized Controlled ◽

Reduction Strategies ◽

Risk Reduction Strategies

There is limited knowledge on non-invasive lymphedema risk-reduction strategies for women with gynecological cancer. Understanding factors influencing the feasibility of randomized controlled trials (RCTs) can guide future research. Our objectives are to report on the design and feasibility of a pilot RCT examining a tailored multidimensional intervention in women treated for gynecological cancer at risk of lymphedema and to explore the preliminary effectiveness of the intervention on lymphedema incidence at 12 months. In this pilot single-blinded, parallel-group, multi-centre RCT, women with newly diagnosed gynecological cancer were randomized to receive post-operative compression stockings and individualized exercise education (intervention group: IG) or education on lymphedema risk-reduction alone (control group: CG). Rates of recruitment, retention and assessment completion were recorded. Intervention safety and feasibility were tracked by monitoring adverse events and adherence. Clinical outcomes were evaluated over 12 months: presence of lymphedema, circumferential and volume measures, body composition and quality of life. Fifty-one women were recruited and 36 received the assigned intervention. Rates of recruitment and 12-month retention were 47% and 78%, respectively. Two participants experienced post-operative cellulitis, prior to intervention delivery. At three and six months post-operatively, 67% and 63% of the IG used compression ≥42 h/week, while 56% engaged in ≥150 weekly minutes of moderate-vigorous exercise. The cumulative incidence of lymphedema at 12 months was 31% in the CG and 31.9% in the IG (p = 0.88). In affected participants, lymphedema developed after a median time of 3.2 months (range, 2.7–5.9) in the CG vs. 8.8 months (range, 2.9–11.8) in the IG. Conducting research trials exploring lymphedema risk-reduction strategies in gynecological cancer is feasible but challenging. A tailored intervention of compression and exercise is safe and feasible in this population and may delay the onset of lymphedema. Further research is warranted to establish the role of these strategies in reducing the risk of lymphedema for the gynecological cancer population.

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