Worldwide medical guidelines adapted after Maastricht research

Worldwide medical guidelines adapted after Maastricht research

2021 Dissertation Prize for Estelle Nijssen

17-05-2022

It is not often that research has an almost immediate and worldwide effect. But it was exactly what happened with the PhD research by Estelle Nijssen, staff researcher Imaging at MUMC+ and CARIM. Together with her team, she looked into the benefit of administering fluids prior to an examination with contrast fluid containing iodine, in order to prevent kidney damage in vulnerable patients. She received the 2021 Dissertation Prize during the Dies Natalis celebrations in the Sint Janskerk on Thursday.

In the Netherlands alone, contrast fluid is used more than a million times every year. It is administered to patients beforehand so that, for example, the organs and blood vessels show better at a CT scan or angioplasty. This could be damaging to patients with weak kidneys, such as the elderly or those suffering from kidney conditions. It is called Contrast Nephropathy: acute kidney damage two to five days after the scan.

Once the damage has occurred, nothing can be done about it, so a great deal of attention was paid to prevention in patients who were at risk. Administering fluids, via a drip, could make the contrast fluid less harmful. “The drip is quite invasive for the patient,” says Nijssen. “They have to be hospitalised for at least a day. Furthermore, kidney problems often go hand in hand with heart problems and the heart can’t always deal with the extra fluid. In those cases, it was administered slowly, spread out over 24 hours.” A person is in hospital all that time. “While the eventual scan without the need for administering fluids doesn’t require hospitalisation and is completed quickly. Scans were sometimes even postponed because there was no bed available.” Then there are also the financial costs: 50 to 100 million per year in the Netherlands.

No control groups

Nevertheless, these were the guidelines everywhere in the world. “In the Netherlands, it was even a requirement, and strict checks were carried out in hospitals.” What surprised Nijssen when she looked at the literature was the fact that there was no study that included a control group. “All research compared the one form of hydration with the other, no one had worked with a control group that didn’t receive fluids and that’s the only way to find out if something really works.” That was the reason for the AMACING study, a collaboration between the departments of Internal Medicine, Cardiology and Imaging of the MUMC+.

Hundreds of at-risk patients who, for all kinds of reasons, were given contrast fluid, participated in the study. Half were given fluids the other half were not. To everyone’s surprise, including the research team themselves, there was absolutely no difference between the two groups. “You can measure kidney damage in the blood using a certain substance. In both groups it was almost the same; 2.6 and 2.7 per cent. Nobody needed dialysis, we saw no related deaths. What we did see, was that patients who were given fluids beforehand had side effects, such as heart failure and tightness of the chest. So, it had no advantages, but disadvantages.”

Abolishing guidelines

Nijssen and her team published the results in The Lancet and after that it took off. “Within a year, the guidelines were adapted, and these patients were no longer given extra fluids, everywhere. I was surprised at the speed, I expected others to first repeat the research. Although the results were very clear.”

Surprise

The Dissertation Prize came as a complete surprise. “That is what I like so much about it. For a lot of prizes, you have to put yourself forward and I am not really one for stages and cameras. I had absolutely no idea about this. It also comes at a great moment. We have just submitted a new article with the five-year results and that means that this project is completely finished.”

Author: Cleo Freriks

Photo: Joey Roberts

Categories: news_top, Science
Tags: diesnatalis2022,dissertation prize,amcing,mumc+,carim,research,study,kidney,heart,instagram

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