The reno-protective effect of hydration with sodium bicarbonate plus N-acetylcysteine in patients undergoing emergency percutaneous coronary intervention: the RENO Study.
OBJECTIVE
This study was designed to determine the effectiveness of a protocol for rapid intravenous hydration to prevent contrast-induced nephropathy (CIN) in patients undergoing emergency percutaneous coronary intervention (PCI).


BACKGROUND
Contrast-induced nephropathy frequently complicates PCI, resulting in prolonged hospitalization and increased in-hospital and long-term morbidity and mortality. Little is known regarding prevention of CIN in patients undergoing urgent PCI.


METHODS
We conducted a prospective, controlled, randomized, single-center trial in 111 consecutive patients with acute coronary syndrome undergoing emergency PCI. As part of the hydration therapy, 56 patients (group A) received an infusion of sodium bicarbonate plus N-acetylcysteine (N-AC) started just before contrast injection and continued for 12 h after PCI. The remaining 55 patients (group B) received the standard hydration protocol consisting of intravenous isotonic saline for 12 h after PCI. In both groups, 2 doses of oral N-AC were administered the next day.


RESULTS
The 2 groups were similar with respect to age, gender, diabetes mellitus, and baseline serum creatinine. A serum creatinine concentration >0.5 mg/dl from baseline after emergency PCI was observed in 1 patient in group A (1.8%) and in 12 patients in group B (21.8%; p < 0.001). Acute anuric renal failure was observed in 1 patient (1.8%) in group A and in 7 patients (12.7%) in group B (p = 0.032).


CONCLUSIONS
Rapid intravenous hydration with sodium bicarbonate plus N-AC before contrast injection is effective and safe in the prevention of CIN in patients undergoing emergency PCI.
Recio-Mayoral
Alejandro
A
Department of Cardiology, Virgen Macarena University Hospital, Seville, Spain. arecio@sgul.ac.uk
Chaparro
Marinela
M
Prado
Belén
B
Cózar
Rocío
R
Méndez
Irene
I
Banerjee
Debasish
D
Kaski
Juan C
JC
Cubero
José
J
Cruz
Jose M
JM
D000111:Acetylcysteine / Q000008:administration & dosage*; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods; D003327:Coronary Disease / Q000503:physiopathology / Q000628:therapy; D004632:Emergency Medical Services / Q000379:methods; D005260:Female; D005440:Fluid Therapy / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016037:Single-Blind Method; D017693:Sodium Bicarbonate / Q000008:administration & dosage*
D017693:Sodium Bicarbonate; D000111:Acetylcysteine