Abstract
Background
Contrast‐induced nephropathy (CIN) is the third cause of acute deterioration of renal function in hospitalized patients.
Hypothesis
The purpose of the study was to compare the efficacy of saline infusion, saline infusion plus N‐acetylcysteine (NAC), and sodium bicarbonate (SB) infusion to prevent CIN in patients undergoing coronary angiography and/or percutaneous coronary intervention.
Methods
We prospectively studied 156 patients with a baseline creatinine level ≥ 1.2 mg/dL. The primary endpoint was the development of CIN, defined as an increase in serum creatinine concentration ≥ 25% over the baseline value within 5 days from contrast exposure.
Results
Contrast‐induced nephropathy developed in 23 patients (14.7%). Incidence of the primary endpoint was similar in the 3 groups of treatment, occurring in 7 patients (14%) in the saline infusion group, in 9 (17%) in the saline infusion plus NAC group, and in 7 (14%) in the SB infusion group.
Conclusions
Our findings suggest that neither the addition of NAC nor the administration of SB add further benefit in CIN prevention, compared to standard hydration with isotonic saline infusion. Copyright © 2009 Wiley Periodicals, Inc.
Full Text
The Full Text of this article is available as a PDF (225.6 KB).
References
- 1. Nash K, Hafeez A, Hou S. Hospital‐acquired renal insufficiency. Am J Kidney Dis 2002; 39: 930–936. [DOI] [PubMed] [Google Scholar]
- 2. Marenzi G, Lauri G, Assanelli E, et al. Contrast‐induced nephropathy in patients undergoing primary angioplasty for acute myocardial infarction. J Am Coll Cardiol 2004; 44: 1780–1785. [DOI] [PubMed] [Google Scholar]
- 3. Rihal CS, Textor SC, Grill DE, et al. Incidence and prognostic importance of acute renal failure after percutaneous coronary intervention. Circulation 2002; 105: 2259–2264. [DOI] [PubMed] [Google Scholar]
- 4. Stacul F, Adam A, Becker CR, et al. Strategies to reduce the risk of contrast‐induced nephropathy. Am J Cardiol 2006; 98: 59K–77K. [DOI] [PubMed] [Google Scholar]
- 5. Schweiger MJ, Chambers CE, Davidson CJ, et al. Prevention of contrast induced nephropathy: recommendations for the high risk patient undergoing cardiovascular procedures. Cathet Cardiovasc Interven 2007; 69: 135–140. [DOI] [PubMed] [Google Scholar]
- 6. Tepel M, Van der Gier M, Schwarzfeld C, Laufer U, Liermann D, Zidek W. Prevention of radiographic‐contrast‐agent‐induced reductions in renal function by acetylcysteine. N Engl J Med 2000; 343: 180–184. [DOI] [PubMed] [Google Scholar]
- 7. Merten GJ, Burgess WP, Gray LV, et al. Prevention of contrast‐induced nephropathy with sodium bicarbonate. A randomized controlled trial. JAMA 2004; 291: 2328–2334. [DOI] [PubMed] [Google Scholar]
- 8. Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med 1999; 130: 461–470. [DOI] [PubMed] [Google Scholar]
- 9. Cigarroa RG, Lange RA, Williams RH, Hillis LD. Dosing of contrast material to prevent contrast nephropathy in patients with renal disease. Am J Med 1989; 86: 649–652. [DOI] [PubMed] [Google Scholar]
- 10. Briguori C, Colombo A, Violante A, et al. Standard vs double dose of N‐acetylcysteine to prevent contrast agent associated nephrotoxicity. Eur Heart J 2004; 25: 206–211. [DOI] [PubMed] [Google Scholar]
- 11. Shyu K, Cheng JT, Kuan P. Acetylcysteine protects against acute renal damage in patients with abnormal renal function undergoing a coronary procedure. J Am Coll Cardiol 2002; 40: 1383–1388. [DOI] [PubMed] [Google Scholar]
- 12. Mueller C, Buerkle G, Buettner HJ, et al. Prevention of contrast media‐associated nephropathy: randomized comparison of 2 hydration regimens in 1620 patients undergoing coronary angioplasty. Arch Intern Med 2002; 162: 329–336. [DOI] [PubMed] [Google Scholar]
- 13. Bader BD, Berger ED, Heede MB, et al. What is the best hydration regimen to prevent contrast media‐induced nephrotoxicity? Clin Nephrol 2004; 6: 1–7. [DOI] [PubMed] [Google Scholar]
- 14. Krasuski RA, Beard BM, Geoghagan JD, Thompson CM, Guidera SA. Optimal timing of hydration to erase contrast‐associated nephropathy: the OTHER CAN study. J Invasive Cardiol 2003; 15: 699–702. [PubMed] [Google Scholar]
- 15. Allaqaband S, Tumuluri R, Malik AM, et al. Prospective randomized study of N‐acetylcysteine, fenoldopam, and saline for prevention of radiocontrast‐induced nephropathy. Catheter Cardiovasc Interv 2002; 57: 279–283. [DOI] [PubMed] [Google Scholar]
- 16. Boccalandro F, Amhad M, Smalling RW, Sdringola S. Oral acetylcysteine does not protect renal function from moderate to high doses of intravenous radiographic contrast. Catheter Cardiovasc Interv 2003; 58: 336–341. [DOI] [PubMed] [Google Scholar]
- 17. Briguori C, Manganelli F, Scarpato P, et al. Acetylcysteine and contrast‐agent associated nephrotoxicity. J Am Coll Cardiol 2002; 40: 298–303. [DOI] [PubMed] [Google Scholar]
- 18. Kay J, Chow WH, Chan TM, et al. Acetylcysteine for prevention of acute deterioration of renal function following elective coronary angiography and intervention: a randomized controlled trial. JAMA 2003; 289: 553–558. [DOI] [PubMed] [Google Scholar]
- 19. Masuda M, Yamada T, Mine T, et al. Comparison of usefulness of sodium bicarbonate versus sodium chloride to prevent contrast‐induced nephropathy in patients undergoing an emergent coronary procedure. Am J Cardiol 2007; 100: 781–786. [DOI] [PubMed] [Google Scholar]
- 20. Recio‐Mayoral A, Chaparro M, Prado B, et al. The reno‐protective effect of hydration with sodium bicarbonate plus N‐acetylcysteine in patients undergoing emergency percutaneous coronary intervention. J Am Coll Cardiol 2007; 49: 1283–1288. [DOI] [PubMed] [Google Scholar]
- 21. Briguori C, Airoldi F, D'Andrea D, et al. Renal insufficiency following contrast media administration trial (REMEDIAL). A randomized comparison of 3 preventive strategies. Circulation 2007; 115: 1211–1217. [DOI] [PubMed] [Google Scholar]
- 22. Ozcan EE, Guneri S, Akdeniz B, et al. Sodium bicarbonate, N‐acetylcysteine, and saline for prevention of radiocontrast‐induced nephropathy. A comparison of 3 regimens for protecting contrast‐induced nephropathy in patients undergoing coronary procedures. A single‐center prospective controlled trial. Am Heart J 2007; 154: 539–544. [DOI] [PubMed] [Google Scholar]
- 23. MEENA (A Randomized Controlled Trial for the Prevention of Contrast‐Induced Nephropathy with Sodium Bicarbonate in Persons Undergoing Coronary Angiography). Clin Cardiol 2007; 30: 416. [Google Scholar]
- 24. From AM, Bartholmai BJ, Williams AW, Cha SS, Pflueger A, McDonald FS. Sodium bicarbonate is associated with an increased incidence of contrast nephropathy: a retrospective cohort study of 7977 patients at Mayo Clinic. Clin J Am Soc Nephrol 2008; 3: 10–18. [DOI] [PMC free article] [PubMed] [Google Scholar]
