[Prevention of contrast-induced nephropathy using cardiac catheterization combined with hydration, oral N-acetylcysteine, sodium bicarbonate and iso-osmolar contrast agents].
OBJECTIVE
Contrast-induced nephropathy (CIN) after coronary angiography is a serious complication with an unfavorable prognosis. If CIN is persistent in the chronic phase, the prognosis is much worsened. We evaluated the efficacy of a new clinical therapy consisting of cardiac catheterization combined with hydration, oral N-acetylcysteine, sodium bicarbonate and iso-osmolar contrast agents.


METHODS
The clinical therapy was applied to patients with pre-existent chronic renal insufficiency who underwent elective coronary angiography between December 2005 and December 2006. The incidence of CIN (defined as an increase > or = 25% and/or > or = 0.5 mg/dl in serum creatinine) persisting in the chronic phase at 30-60 days was examined in therapy era patients and compared with non-therapy era patients treated between January 2004 and November 2005, as well as patients with creatinine clearance < 40 ml/min.


RESULTS
The clinical therapy was applied to 31 of 517 consecutive patients who underwent coronary angiography. CIN persisting in the chronic phase at 30-60 days occurred in 28 of 808 consecutive non-therapy era patients and 8 of 517 consecutive therapy era patients (3.5% vs 1.8%, p < 0.05). Excluding emergent cases, it occurred in 23 of 752 non-therapy era patients and 5 of 466 therapy era patients (3.1% vs 1.1%, p < 0.05). The patients with pre-existent chronic renal insufficiency (creatinine clearance < 40 ml/min) included 66 non-therapy era patients, and 21 of 31 therapy patients. Serum creatinine increased in the non-therapy era group (p < 0.01), but not in the therapy group. CIN persisting in the chronic phase at 30-60 days occurred in 21 non-therapy era group but in none of the therapy group.


CONCLUSIONS
Therapy for patients with renal failure consisting of cardiac catheterization combined with hydration, oral N-acetylcysteine, sodium bicarbonate and iso-osmolar contrast agents is effective to prevent CIN in the chronic phase.
Hoshino
Atsushi
A
Department of Cardiology, Saiseikai Shiga Hospital, Shiga. a-hoshi@koto.kpu-m.ac.jp
Enomoto
Satoko
S
Kawahito
Hiroyuki
H
Kurata
Hiroyuki
H
Nakahara
Yoshifumi
Y
Nakamura
Takashi
T
D000111:Acetylcysteine / Q000008:administration & dosage*; D000284:Administration, Oral; D000368:Aged; D006328:Cardiac Catheterization; D003287:Contrast Media / Q000009:adverse effects*; D017023:Coronary Angiography; D019091:Critical Pathways; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000139:chemically induced / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D009994:Osmolar Concentration; D051436:Renal Insufficiency, Chronic / Q000517:prevention & control; D017693:Sodium Bicarbonate / Q000008:administration & dosage*