It is not only fluids: the impact of hydration protocols used for the prevention of contrast nephropathy on renal oxygenation
Fluid administration is the mainstay intervention effective in the prevention of radiocontrast-associated nephropathy (CAN) in high-risk patients. Vigorous hydration shortens intratubular solute transit-time and reduces tubular intraluminal concentration of contrast media (CM), decreasing exposure o...
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| Format: | Article |
| Language: | English |
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Taylor & Francis Group
2025-12-01
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| Series: | Renal Failure |
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| Online Access: | https://www.tandfonline.com/doi/10.1080/0886022X.2025.2528889 |
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| author | Samuel N. Heyman Richard Solomon Zaid Abassi |
| author_facet | Samuel N. Heyman Richard Solomon Zaid Abassi |
| author_sort | Samuel N. Heyman |
| collection | DOAJ |
| description | Fluid administration is the mainstay intervention effective in the prevention of radiocontrast-associated nephropathy (CAN) in high-risk patients. Vigorous hydration shortens intratubular solute transit-time and reduces tubular intraluminal concentration of contrast media (CM), decreasing exposure of tubular cells to CM and reducing renal parenchymal retention of the nephrotoxin. Lowered plasma and urine viscosity might also improve vasa recta flow and renal interstitial pressure, improving compromised renal parenchymal microcirculation and oxygenation. Herein we emphasize the overlooked plausible role of down-regulation of tubular transport, generated by vigorous hydration in the mitigation of medullary hypoxia and hypoxic medullary damage generated in CAN. Volume expansion triggers natriuretic peptides that improve renal parenchymal oxygenation and may attenuate hypoxic renal injury. Furthermore, enhanced large-volume hydration protocols used for high-risk patients undergoing coronary interventions or transcatheter aortic valve implantation include the administration of furosemide. Loop diuretics block oxygen consumption in medullary thick ascending limbs, improve medullary oxygenation and prevent outer medullary injury in experimental CAN. Thus, fluids are likely not the sole issue, and restoration of medullary oxygenation is critical in attenuating the risk of CAN by large volume hydration protocols for high-risk patients. |
| format | Article |
| id | doaj-art-81fa5b94918d4dedbb1c41f5eb835884 |
| institution | DOAJ |
| issn | 0886-022X 1525-6049 |
| language | English |
| publishDate | 2025-12-01 |
| publisher | Taylor & Francis Group |
| record_format | Article |
| series | Renal Failure |
| spelling | doaj-art-81fa5b94918d4dedbb1c41f5eb8358842025-08-20T02:40:20ZengTaylor & Francis GroupRenal Failure0886-022X1525-60492025-12-0147110.1080/0886022X.2025.2528889It is not only fluids: the impact of hydration protocols used for the prevention of contrast nephropathy on renal oxygenationSamuel N. Heyman0Richard Solomon1Zaid Abassi2Department of Medicine, Hadassah Hebrew University Hospital, Jerusalem, IsraelDepartment of Nephrology, The University of Vermont Medical Center, Burlington, Vermont, USADepartment of Physiology, Bruce Rappaport School of Medicine, Technion, Haifa, IsraelFluid administration is the mainstay intervention effective in the prevention of radiocontrast-associated nephropathy (CAN) in high-risk patients. Vigorous hydration shortens intratubular solute transit-time and reduces tubular intraluminal concentration of contrast media (CM), decreasing exposure of tubular cells to CM and reducing renal parenchymal retention of the nephrotoxin. Lowered plasma and urine viscosity might also improve vasa recta flow and renal interstitial pressure, improving compromised renal parenchymal microcirculation and oxygenation. Herein we emphasize the overlooked plausible role of down-regulation of tubular transport, generated by vigorous hydration in the mitigation of medullary hypoxia and hypoxic medullary damage generated in CAN. Volume expansion triggers natriuretic peptides that improve renal parenchymal oxygenation and may attenuate hypoxic renal injury. Furthermore, enhanced large-volume hydration protocols used for high-risk patients undergoing coronary interventions or transcatheter aortic valve implantation include the administration of furosemide. Loop diuretics block oxygen consumption in medullary thick ascending limbs, improve medullary oxygenation and prevent outer medullary injury in experimental CAN. Thus, fluids are likely not the sole issue, and restoration of medullary oxygenation is critical in attenuating the risk of CAN by large volume hydration protocols for high-risk patients.https://www.tandfonline.com/doi/10.1080/0886022X.2025.2528889Radiocontrast nephropathyhypoxiafluidsdiureticsfurosemidemedulla |
| spellingShingle | Samuel N. Heyman Richard Solomon Zaid Abassi It is not only fluids: the impact of hydration protocols used for the prevention of contrast nephropathy on renal oxygenation Renal Failure Radiocontrast nephropathy hypoxia fluids diuretics furosemide medulla |
| title | It is not only fluids: the impact of hydration protocols used for the prevention of contrast nephropathy on renal oxygenation |
| title_full | It is not only fluids: the impact of hydration protocols used for the prevention of contrast nephropathy on renal oxygenation |
| title_fullStr | It is not only fluids: the impact of hydration protocols used for the prevention of contrast nephropathy on renal oxygenation |
| title_full_unstemmed | It is not only fluids: the impact of hydration protocols used for the prevention of contrast nephropathy on renal oxygenation |
| title_short | It is not only fluids: the impact of hydration protocols used for the prevention of contrast nephropathy on renal oxygenation |
| title_sort | it is not only fluids the impact of hydration protocols used for the prevention of contrast nephropathy on renal oxygenation |
| topic | Radiocontrast nephropathy hypoxia fluids diuretics furosemide medulla |
| url | https://www.tandfonline.com/doi/10.1080/0886022X.2025.2528889 |
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