Effect of No Prehydration vs Sodium Bicarbonate Prehydration Prior to Contrast-Enhanced Computed Tomography in the Prevention of Postcontrast Acute Kidney Injury in Adults With Chronic Kidney Disease The Kompas Randomized Clinical Trial

Importance Prevention of postcontrast acute kidney injury in patients with stage 3 chronic kidney disease (CKD) by means of prehydration has been standard care for years. However, evidence for the need for prehydration in this group is limited. Objective To assess the renal safety of omitting prophylactic prehydration prior to iodine-based contrast media administration in patients with stage 3 CKD. Design, Setting, and Participants The Kompas trial was a multicenter, noninferiority, randomized clinical trial conducted at 6 hospitals in the Netherlands in which 523 patients with stage 3 CKD were randomized in a 1:1 ratio to receive no prehydration or prehydration with 250 mL of 1.4% sodium bicarbonate administered in a 1-hour infusion before undergoing elective contrast-enhanced computed tomography from April 2013 through September 2016. Final follow-up was completed in September 2017. Data were analyzed from January 2018 to June 2019. Interventions In total, 262 patients were allocated to the no prehydration group and 261 were allocated to receive prehydration. Analysis on the primary end point was available in 505 patients (96.6%). Main Outcomes and Measures The primary end point was the mean relative increase in serum creatinine level 2 to 5 days after contrast administration compared with baseline (noninferiority margin of less than 10% increase in serum creatinine level). Secondary outcomes included the incidence of postcontrast acute kidney injury 2 to 5 days after contrast administration, mean relative increase in creatinine level 7 to 14 days after contrast administration, incidences of acute heart failure and renal failure requiring dialysis, and health care costs. Results Of 554 patients randomized, 523 were included in the intention-to-treat analysis. The median (interquartile range) age was 74 (67-79) years; 336 (64.2%) were men and 187 (35.8%) were women. The mean (SD) relative increase in creatinine level 2 to 5 days after contrast administration compared with baseline was 3.0% (10.5) in the no prehydration group vs 3.5% (10.3) in the prehydration group (mean difference, 0.5; 95% CI, -1.3 to 2.3; P <.001 for noninferiority). Postcontrast acute kidney injury occurred in 11 patients (2.1%), including 7 of 262 (2.7%) in the no prehydration group and 4 of 261 (1.5%) in the prehydration group, which resulted in a relative risk of 1.7 (95% CI, 0.5-5.9; P = .36). None of the patients required dialysis or developed acute heart failure. Subgroup analyses showed no evidence of statistical interactions between treatment arms and predefined subgroups. Mean hydration costs were euro119 (US $143.94) per patient in the prehydration group compared with euro0 (US$0) in the no prehydration group (P <.001). Other health care costs were similar. Conclusions and Relevance Among patients with stage 3 CKD undergoing contrast-enhanced computed tomography, withholding prehydration did not compromise patient safety. The findings of this study support the option of not giving prehydration as a safe and cost-efficient measure

Guidelines for designing a realistic peripheral venous catheter insertion simulator: A literature review

International audienceA literature review was conducted to develop more realistic medical simulators that better prepare aspiring health professionals to perform a medical procedure in vivo. Thus, this review proposes an approach that might assist researchers design improved medical simulators, particularly new materials that would enhance the sensation of touch for skin substitutes. By targeting the current needs in the field of simulation learning, we concluded that peripheral venous catheter insertion (PVCI) simulators lack realistic haptic feedback. Enhanced PVCI simulators will accelerate the mastery of the medical procedure, thus decreasing the number of failures in patients and costs related to this procedure

Bulletin d'histoire de Belgique 1957-1958

Dhondt Jean, Vermeersch A., Brulez Wilfrid, Craeybeckx Jan, Deprez Paul, Kruithof J., Luypaert O., Prevenier Walter, Van Caenegem Raoul C., Verhulst Adriaan. Bulletin d'histoire de Belgique 1957-1958. In: Revue du Nord, tome 41, n°161, Janvier-mars 1959. pp. 53-112

Bulletin d'Histoire de Belgique 1958-1959

Dhondt Jean, Brulez Wilfrid, Craeybeckx Jan, Deprez Paul, Kruithof J., Luypaert O., Prevenier Walter, Van Caenegem Raoul C., Van der Veeghde D., Van Eenoo Romain, Verhulst Adriaan, Vermeersch A. Bulletin d'Histoire de Belgique 1958-1959. In: Revue du Nord, tome 42, n°165, Janvier-mars 1960. pp. 95-150

Bulletin d'Histoire de Belgique 1959-1960

Dhondt Jean, Brulez Wilfrid, Craeybeckx Jan, Deprez Paul, Prevenier Walter, Van Caenegem Raoul C., Van der Veeghde D., Van Eenoo Romain, Verhelst J., Verhulst Adriaan, Vermeersch A., Vervaeck Solange, Scholliers S. Bulletin d'Histoire de Belgique 1959-1960. In: Revue du Nord, tome 43, n°169, Janvier-mars 1961. pp. 69-116