Prevention of Contrast-Induced Nephropathy with the Combination of Sodium Bicarbonate and N-Acetylcysteine: A Randomized Controlled Trial
نویسنده
چکیده
Following coronary angiography, approximately 14.5% of patients develop contrast induced nephropathy (CIN). In addition, CIN accounts for more than 10% of hospital acquired renal failure. Not only is CIN associated with increased lengths of stay, but also with worsening of baseline renal function, and, rarely, progression to hemodialysis. Most importantly, CIN is associated with increased short and long term mortality. Several studies have shown that the risk factors for developing CIN include baseline renal impairment, diabetes mellitus, and larger contrast loads (as with coronary angiography). While the exact pathophysiology of CIN is not known, it is thought that iodinated radiographic contrast causes direct tubular toxicity via free radical formation (which is promoted by the acidic tubular environment), and by tubular vasoconstriction leading to ischemic injury. Based on these insights, many attempts have been made to prevent CIN. It is now well established that the use of low osmolarity, non-ionic contrast agents is associated with decreased risk of CIN. In addition, good evidence supports the use of the free radical scavenger N-Acetylcysteine (NAC) for the prevention of CIN. Perhaps most widely accepted, intravenous hydration is considered integral for the prevention of CIN. In this setting, normal saline is the most frequently used intravenous fluid as it was shown in one study to be more effective than half-normal saline. Most recently, however, new evidence suggests that hydration with sodium bicarbonate is more effective for prevention of CIN than hydration with normal saline. This study is designed to determine if there is a role for sodium bicarbonate in addition to NAC in the prevention of CIN in patients with renal insufficiency undergoing coronary angiography.
منابع مشابه
Sodium bicarbonate therapy for prevention of contrast-induced nephropathy: a systematic review and meta-analysis.
BACKGROUND Optimal hydration measures to prevent contrast-induced nephropathy are controversial. STUDY DESIGN We conducted a systematic review and meta-analysis using the MEDLINE database (1966 to January 2008), EMBASE (January 2008), and abstracts from conference proceedings. SETTING & POPULATION Adult patients undergoing contrast procedures. SELECTION CRITERIA FOR STUDIES Randomized con...
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A randomized controlled trial. J Am Coll Cardiol 2007; 50: 1015– 1020 7. Tepel M, Van Der Giet M, Schwarzfeld C et al. Prevention of radiographic-contrast-agent-induced reductions in renal function by acetylcysteine. N Engl J Med 2000; 343: 180–184 8. Merten GJ, Burgess WP, Gray LV et al. Prevention of contrast-induced nephropathy with sodium bicarbonate: a randomized controlled trial. JAMA 200...
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BACKGROUND Contrast-induced nephropathy (CIN) is a serious condition in patients with ST-segment-elevation myocardial infarction treated with primary percutaneous coronary intervention. We compared the risk of acute CIN and the influence of preventive strategies in patients with ST-segment-elevation myocardial infarction undergoing primary percutaneous coronary intervention. METHODS AND RESUL...
متن کاملPrevention of Contrast-Induced Nephropathy With Sodium Bicarbonate A Randomized Controlled Trial
THE INCREASING NUMBER OF DIagnostic procedures requiring radiographic contrast has triggered a parallel increase in the incidence of contrast-induced nephropathy, which accounts for more than 10% of hospital-acquired renal failure and is a leading cause of acute renal failure. Compromise of renal function increases morbidity, mortality, length of hospitalization, and acceleration toward end-sta...
متن کاملSodium bicarbonate versus saline for the prevention of contrast-induced nephropathy in patients with renal dysfunction undergoing coronary angiography or intervention.
OBJECTIVES The purpose of this study was to compare the efficacy of sodium bicarbonate versus isotonic saline in addition to N-acetylcysteine (NAC) to prevent contrast-induced nephropathy (CIN) in a larger population of patients with renal dysfunction undergoing coronary angiography or intervention. BACKGROUND Contrast-induced nephropathy accounts for more than 10% of hospital-acquired renal ...
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