OBJECTIVE Guidelines on safe use of iodinated contrast material recommend intravenous prophylactic hydration to prevent post-contrast adverse (renal) effects. Recently, guidelines have been updated and standard prophylaxis is no longer recommended for the majority of patients. The current study aims to evaluate the consequences for clinical practice of the updated guidelines in terms of complications, hospitalisations, and costs. METHODS The Contrast-Induced Nephropathy After Reduction of the prophylaxis Threshold (CINART) project is a retrospective observational study. All elective procedures with intravascular iodinated contrast administration at Maastricht University Medical Centre (UMC+) in patients aged > 18 years, formerly eligible for prophylaxis (eGFR 30-44 ml/min/1.73 m2 or eGFR 45-59 ml/min/1.73 m2 in combination with diabetes or > 1 predefined risk factor), and currently eligible for prophylaxis (eGFR < 30 ml/min/1.73 m2) were included. Data were used to calculate relative reductions in complications, hospitalisations, and costs associated with standard prophylactic intravenous hydration. CINART is registered with Clinicaltrials.gov: NCT03227835. RESULTS Between July 1, 2017, and July 1, 2018, 1992 elective procedures with intravascular iodinated contrast in patients formerly and currently eligible for prophylaxis were identified: 1808 in patients formerly eligible for prophylaxis and 184 in patients currently eligible for prophylaxis. At Maastricht UMC+, guideline updates led to large relative reductions in numbers of complications of prophylaxis (e.g. symptomatic heart failure; - 89%), extra hospitalisations (- 93%), and costs (- 91%). CONCLUSION Guideline updates have had a demonstrable impact on daily clinical practice benefiting patient, hospital, and health care budgets. Clinical practice varies between institutions and countries; therefore, a local estimation model is provided with which local impact on costs, hospitalisations, and complications can be calculated. KEY POINTS • Clinical practice guidelines recommend prophylactic intravenous hydration to prevent post-contrast adverse outcomes such as contrast-induced acute kidney injury. • Clinical practice guidelines have recently been updated, and standard prophylaxis is no longer recommended for the majority of patients. • The guideline updates have a large impact on daily clinical practice: relative reductions at Maastricht UMC+ were - 89% prophylaxis complications, - 93% hospitalisations, and - 91% costs, and similar reductions are expected for Dutch and adherent European medical centres.

中文翻译：

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含碘对比剂最新指南对临床实践的影响：CINART。

目的安全使用碘化造影剂的指南建议静脉内预防性补充水分，以防止造影剂后产生不良（肾脏）影响。最近，指南已更新，大多数患者不再建议标准的预防措施。本研究旨在从并发症，住院和费用方面评估更新指南对临床实践的影响。方法降低预防性阈值（CINART）项目后的造影剂诱发的肾病是一项回顾性观察研究。在马斯特里赫特大学医学中心（UMC +）对年龄≥18岁的患者进行了所有血管内碘造影剂的选择性治疗，以前有资格进行预防（eGFR 30-44 ml / min / 1.73 m2或eGFR 45-59 ml / min / 1.73 m2合并糖尿病或> 其中包括1个预先定义的危险因素），并且目前符合预防条件（eGFR <30 ml / min / 1.73 m2）。数据用于计算与标准预防性静脉水合作用相关的并发症，住院和费用的相对减少。CINART已在Clinicaltrials.gov上注册：NCT03227835。结果在2017年7月1日至2018年7月1日之间，确定了1992年以前有资格进行预防的患者进行血管内碘造影的选择性手术：以前有资格进行预防的患者为1808例，目前有预防的患者为184例。在马斯特里赫特UMC +，指南的更新导致预防并发症（例如，有症状的心力衰竭；-89％），额外住院（-93％）和费用（-91％）的发生率相对减少。结论指南更新对日常临床实践产生了明显的影响，使患者，医院和医疗保健预算受益。不同机构和国家/地区的临床实践有所不同；因此，提供了一个本地估计模型，可以使用该模型来估算对成本，住院和并发症的本地影响。要点•临床实践指南建议预防性静脉补液，以防止造影剂引起的不良后果，例如造影剂引起的急性肾损伤。•临床实践指南最近已更新，不再建议大多数患者进行标准预防。•指南更新对日常临床实践具有重大影响：马斯特里赫特UMC +的相对减少量是-预防并发症89％，住院93％和费用91％，