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Oral volume expansion may have some benefit, but there is not enough evidence to show that it is as effective as i.v. volume expansion.490 One small RCT of 53 patients491 who underwent nonemergent cardiac catheterization found that i.v. volume expansion with saline was more effective than unrestricted oral fluid intake. A more recent trial492 examined the effects of oral volume intake on renal function in 180 patients with preserved renal function referred for coronary CT angiography. The patients were divided into two groups: 106 subjects with an increase in SCr after coronary CT angiography; and 74 without. Significant correlations were observed between the amount of oral fluid intake and the percentage changes in SCr as well as the absolute changes in eGFR. In multiple regression analysis, the amount of oral fluid intake was the only independent predictor for an increase in SCr. However, a recent study compared oral fluids (water with or without bicarbonate) to i.v. fluids (isotonic saline or bicarbonate) and did not find differences in incidence of CI-AKI patients with mild CKD. If confirmed in larger studies, this regimen could offer an equivalent and more practical approach in preventing a decline in renal function after contrast exposure, without accruing additional delay in hospital days or in-hospital mortality.493
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