Prevention of contrast-induced nephropathy: a single center randomized study.
BACKGROUND
Contrast-induced nephropathy (CIN) is the third cause of acute deterioration of renal function in hospitalized patients.


OBJECTIVE
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 > or = 1.2 mg/dL. The primary endpoint was the development of CIN, defined as an increase in serum creatinine concentration > or = 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.
Castini
Diego
D
Divisione di Cardiologia, Dipartimento di Medicina, Chirurgia, Odontoiatria, Ospedale San Paolo, University of Milan, Via A. di Rudiní 8, Milan, Italy. diegocarlo.castini@fastwebnet.it
Lucreziotti
Stefano
S
Bosotti
Laura
L
Salerno Uriarte
Diego
D
Sponzilli
Carlo
C
Verzoni
Alessandro
A
Lombardi
Federico
F
D000111:Acetylcysteine / Q000008:administration & dosage / Q000627:therapeutic use*; D000208:Acute Disease; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods; D003287:Contrast Media / Q000009:adverse effects*; D017023:Coronary Angiography / Q000379:methods; D005260:Female; D016166:Free Radical Scavengers / Q000008:administration & dosage / Q000627:therapeutic use*; D005919:Glomerular Filtration Rate; D006801:Humans; D015994:Incidence; D007674:Kidney Diseases / Q000139:chemically induced / Q000517:prevention & control*; D008297:Male; D011446:Prospective Studies; D017693:Sodium Bicarbonate / Q000008:administration & dosage / Q000627:therapeutic use*; D012965:Sodium Chloride / Q000008:administration & dosage / Q000627:therapeutic use*
D003287:Contrast Media; D016166:Free Radical Scavengers; D012965:Sodium Chloride; D017693:Sodium Bicarbonate; D000111:Acetylcysteine