title: Prevention of contrast-induced acute kidney injury in patients with stable chronic renal disease undergoing elective percutaneous coronary and peripheral interventions: randomized comparison of two preventive strategies.
abstract: OBJECTIVE
  We compared use of intravenous (IV) normal saline (NS) to sodium bicarbonate (NaHCO(3)) with or without oral N-acetylcysteine (NAC) for prevention of contrast-induced acute kidney injury (CI-AKI).
  
  
  BACKGROUND
  CI-AKI is associated with significant adverse clinical events. Use of NAC has produced variable results. Recently, intravenous hydration with NaHCO(3) for CI-AKI prophylaxis has been adopted as standard treatment for patients with stable chronic renal disease undergoing catheterization procedures.
  
  
  METHODS
  We prospectively enrolled 320 patients with baseline renal insufficiency scheduled to undergo catheterization. Patients were randomly assigned to receive either IV NS ± NAC (n = 161) or IV dextrose 5% in water containing 154 mEq/l of NaHCO(3) ± NAC (n = 159). IV NS was administered at 1 ml/kg body weight for 12 hr preprocedure and 12 more hr postprocedure. IV NaHCO(3) was administered at 3 ml/kg body weight for 1 hr preprocedure followed by 1 ml/kg body weight postprocedure. A 1,200 mg oral dose of NAC was given 2-12 hr preprocedure and 6-12 hr postprocedure in 50% of patients in each study arm. CI-AKI was defined as an increase of >0.5 mg/dl or >25% above baseline creatinine.
  
  
  RESULTS
  Overall incidence of CI-AKI was 10.3%. There was no significant difference in incidence among the two groups (NS ± NAC 11.8% vs. NaHCO(3) ± NAC 8.8%, p = ns). Incidence of CI-AKI increased with increasing age (p = 0.001), contrast agent use >3 ml/kg body weight (p = 0.038) and diuretic use (p = 0.005).
  
  
  CONCLUSIONS
  Incidence of CI-AKI was no different in the NaHCO(3) group compared to NS group, and NAC did not reduce CI-AKI in the two study arms.
authors.affiliation: Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers University of Wisconsin School of Medicine and Public Health Milwaukee, Wisconsin, USA.
authors.forename: Abdul Moiz
authors.initials: AM
authors.lastname: Hafiz
authors.forename: M Fuad
authors.initials: MF
authors.lastname: Jan
authors.forename: Naoyo
authors.initials: N
authors.lastname: Mori
authors.forename: Fareed
authors.initials: F
authors.lastname: Shaikh
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Wallach
authors.forename: Tanvir
authors.initials: T
authors.lastname: Bajwa
authors.forename: Suhail
authors.initials: S
authors.lastname: Allaqaband
mesh_terms: D000111:Acetylcysteine / Q000008:administration & dosage; D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D006328:Cardiac Catheterization; D002406:Catheterization, Peripheral; D016009:Chi-Square Distribution; D003287:Contrast Media / Q000009:adverse effects*; D017023:Coronary Angiography / Q000009:adverse effects*; D003404:Creatinine / Q000097:blood; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D006801:Humans; D007262:Infusions, Intravenous; D007674:Kidney Diseases / Q000097:blood / Q000139:chemically induced / Q000175:diagnosis / Q000517:prevention & control*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D051437:Renal Insufficiency / Q000097:blood / Q000150:complications* / Q000175:diagnosis; D018570:Risk Assessment; D012307:Risk Factors; D017693:Sodium Bicarbonate / Q000008:administration & dosage*; D012965:Sodium Chloride / Q000008:administration & dosage*; D013997:Time Factors; D016896:Treatment Outcome; D014652:Vascular Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D014922:Wisconsin
chemical_list: D015415:Biomarkers; D003287:Contrast Media; D012965:Sodium Chloride; D017693:Sodium Bicarbonate; D003404:Creatinine; D000111:Acetylcysteine