title: Prevention of contrast-induced nephropathy: A randomized controlled trial of sodium bicarbonate and N-acetylcysteine.
abstract: BACKGROUND
  Contrast-induced nephropathy (CIN) continues to be a common cause of acute renal failure in high-risk patients undergoing radiocontrast studies. However, there is still a lack of consensus regarding the most effective measures to prevent CIN.
  
  
  METHODS
  ONE HUNDRED EIGHTEEN PATIENTS WITH DIABETES MELLITUS AND/OR RENAL INSUFFICIENCY, SCHEDULED FOR CORONARY ANGIOGRAPHY OR INTERVENTION, WERE RANDOMLY ASSIGNED TO ONE OF FOUR TREATMENT GROUPS: intravenous (IV) 0.9% NaCl alone, IV 0.9% NaCl plus N-acetylcysteine (NAC), IV 0.9% sodium bicarbonate (NaHCO(3)) alone or IV 0.9% NaHCO(3) plus NAC. All patients received IV hydration as a preprocedure bolus and as maintenance. Iso-osmolar contrast was used in all patients. CIN was defined as an increase of greater than 25% in the serum creatinine concentration from baseline to 72 h.
  
  
  RESULTS
  The overall incidence of CIN was 6%. There was no statistically significant difference in the incidence of CIN among the groups. There was a CIN incidence of 7% in the NaCl only group, 5% in the NaCl/NAC group, 11% in the NaHCO(3) only group and 4% in the NaHCO(3)/NAC group (P=0.86). The maximum increase in serum creatinine was 14.14±12.38 μmol/L in the NaHCO(3) group, 10.60±29.14 μmol/L in the NaCl only group, 9.72±13.26 μmol/L in the NaCl/NAC group and 0.177±15.91 μmol/L for the NaHCO(3)/NAC group (P=0.0792).
  
  
  CONCLUSIONS
  CIN in high-risk patients may be effectively minimized solely through the use of an aggressive hydration protocol and an iso-osmolar contrast agent. The addition of NaHCO(3) and/or NAC did not have an effect on the incidence of CIN.
authors.affiliation: Department of Medicine;
authors.forename: Justin A
authors.initials: JA
authors.lastname: Ratcliffe
authors.forename: Prashan
authors.initials: P
authors.lastname: Thiagarajah
authors.forename: Jennifer
authors.initials: J
authors.lastname: Chen
authors.forename: Gita
authors.initials: G
authors.lastname: Kavala
authors.forename: Yumiko
authors.initials: Y
authors.lastname: Kanei
authors.forename: John
authors.initials: J
authors.lastname: Fox
authors.forename: Ramesh
authors.initials: R
authors.lastname: Gowda
authors.forename: Sabrina J
authors.initials: SJ
authors.lastname: Schmitz
authors.forename: Patricia
authors.initials: P
authors.lastname: Friedmann
authors.forename: Steven
authors.initials: S
authors.lastname: Bergmann