Describe the recommended periprocedural hydration to prevent contrast-induced AKI.

• A. 1-1.5 mL/kg/hr of IV normal saline starting 12 hours prior to procedure until 6-24 hours postprocedure
• B. 0.5 mL/kg/hr
• C. 2-3 mL/kg/hr during the procedure only
• D. No hydration is recommended

Answer: (A)

Hydration with isotonic saline around the time of contrast exposure helps protect the kidneys by expanding intravascular volume, improving renal perfusion, and promoting diuresis to dilute and clear the contrast faster. This reduces the tendency for the contrast to cause vasoconstriction and tubular injury.

The recommended approach uses a moderate, continuous infusion of normal saline at about 1 to 1.5 mL per kilogram of body weight per hour, started well before the procedure and continued after it. Beginning hydration about 12 hours before ensures the kidneys have adequate circulating volume ahead of contrast exposure, while continuing for 6 to 24 hours afterward helps maintain perfusion and supports clearance of the contrast during the recovery period. This regimen strikes a balance between providing kidney protection and avoiding fluid overload in patients who may be at risk (such as those with heart failure or kidney dysfunction). Inadequate hydration or hydration limited to the procedure itself does not provide the same protective effect, and skipping hydration altogether increases the risk of contrast-induced AKI.