title: Preventive strategies of renal insufficiency in patients with diabetes undergoing intervention or arteriography (the PREVENT Trial).
abstract: Few studies have compared the ability of sodium bicarbonate plus N-acetylcysteine (NAC) and sodium chloride plus NAC to prevent contrast-induced nephropathy (CIN) in diabetic patients with impaired renal function undergoing coronary or endovascular angiography or intervention. Diabetic patients (n = 382) with renal disease (serum creatinine ≥1.1 mg/dl and estimated glomerular filtration rate <60 ml/min/1.73 m(2)) were randomly assigned to receive prophylactic sodium chloride (saline group, n = 189) or sodium bicarbonate (bicarbonate group, n = 193) before elective coronary or endovascular angiography or intervention. All patients received oral NAC 1,200 mg 2 times/day for 2 days. The primary end point was CIN, defined as an increase in serum creatinine >25% or an absolute increase in serum creatinine ≥0.5 mg/dl within 48 hours after contrast exposure. There were no significant between-group differences in baseline characteristics. The primary end point was met in 10 patients (5.3%) in the saline group and 17 (9.0%) in the bicarbonate group (p = 0.17), with 2 (1.1%) and 4 (2.1%), respectively, requiring hemodialysis (p = 0.69). Rates of death, myocardial infarction, and stroke did not differ significantly at 1 month and 6 months after contrast exposure. In conclusion, hydration with sodium bicarbonate is not superior to hydration with sodium chloride in preventing CIN in patients with diabetic nephropathy undergoing coronary or endovascular angiography or intervention.
authors.affiliation: Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Seung-Whan
authors.initials: SW
authors.lastname: Lee
authors.forename: Won-Jang
authors.initials: WJ
authors.lastname: Kim
authors.forename: Young-Hak
authors.initials: YH
authors.lastname: Kim
authors.forename: Seong-Wook
authors.initials: SW
authors.lastname: Park
authors.forename: Duk-Woo
authors.initials: DW
authors.lastname: Park
authors.forename: Sung-Cheol
authors.initials: SC
authors.lastname: Yun
authors.forename: Jong-Young
authors.initials: JY
authors.lastname: Lee
authors.forename: Soo-Jin
authors.initials: SJ
authors.lastname: Kang
authors.forename: Cheol Whan
authors.initials: CW
authors.lastname: Lee
authors.forename: Jae-Hwan
authors.initials: JH
authors.lastname: Lee
authors.forename: Si Wan
authors.initials: SW
authors.lastname: Choi
authors.forename: In-Whan
authors.initials: IW
authors.lastname: Seong
authors.forename: Jon
authors.initials: J
authors.lastname: Suh
authors.forename: Yoon Haeng
authors.initials: YH
authors.lastname: Cho
authors.forename: Nae-Hee
authors.initials: NH
authors.lastname: Lee
authors.forename: Sang-Sig
authors.initials: SS
authors.lastname: Cheong
authors.forename: Sang-Yong
authors.initials: SY
authors.lastname: Yoo
authors.forename: Bong-Ki
authors.initials: BK
authors.lastname: Lee
authors.forename: Sang-Gon
authors.initials: SG
authors.lastname: Lee
authors.forename: Min-Su
authors.initials: MS
authors.lastname: Hyon
authors.forename: Won-Yong
authors.initials: WY
authors.lastname: Shin
authors.forename: Se-Whan
authors.initials: SW
authors.lastname: Lee
authors.forename: Jae-Sik
authors.initials: JS
authors.lastname: Jang
authors.forename: Seung-Jung
authors.initials: SJ
authors.lastname: Park
mesh_terms: D000111:Acetylcysteine / Q000008:administration & dosage*; D000284:Administration, Oral; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D003287:Contrast Media / Q000009:adverse effects*; D017023:Coronary Angiography / Q000009:adverse effects*; D003404:Creatinine / Q000097:blood; D003928:Diabetic Nephropathies / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D051437:Renal Insufficiency / Q000139:chemically induced / Q000517:prevention & control*; D017693:Sodium Bicarbonate / Q000008:administration & dosage*; D012965:Sodium Chloride / Q000008:administration & dosage*
chemical_list: D003287:Contrast Media; D012965:Sodium Chloride; D017693:Sodium Bicarbonate; D003404:Creatinine; D000111:Acetylcysteine