title: Bicarbonates for the prevention of postoperative renal failure in endovascular aortic aneurysm repair: a randomized pilot trial.
abstract: Purpose. Contrast-induced nephropathy (CIN) can contribute to acute kidney injury (AKI) in patients undergoing endovascular aortic aneurysm surgery. We evaluated the incidence of AKI together with the evolution of early biomarkers of renal injury in patients receiving bicarbonates or NaCl 0.9%. Methods. This study involved endovascular aortic aneurysm surgery patients. Group A (n = 17) received bicarbonates 3 mL/kg/h for 1 h before the procedure and then 1 mL/kg/h until 6 h after surgery, whereas group B (n = 17) received NaCl 0.9% using the same protocol. Biomarkers of renal injury from urine (interleukin-18 (IL-18), neutrophil gelatinase-associated lipocalin (NGAL), N-acetyl-β-D-glucosaminidase (NAG), and kidney injury molecule 1 (KIM-1)) and blood (NGAL, cystatin C) were measured at baseline and 3, 24, and 48 h postoperatively. Results. AKI occurred in 1 patient (2.9%), in the bicarbonates group. IL-18, NAG, NGAL, and KIM-1 significantly rose in both groups after the surgery. There was a greater rise in NGAL and IL-18 after 3 h in the bicarbonates versus NaCl 0.9% group: 1115% versus 240% increase (P = 0.03) and 338% increase versus 1.4% decrease (P = 0.01). Conclusions. Despite significant elevation in biomarkers of renal injury, we demonstrated a low rate of AKI following endovascular aortic surgery.
authors.affiliation: Anesthesiology Department, University of Montreal Hospital Centre, 3840 St. Urbain Street, Montréal, QC, Canada H2W 1T8 ; Department of Anesthesiology, Maisonneuve-Rosemont Hospital, 5415 Boulevard de l'Assomption, Montréal, QC, Canada H1T 2M4.
authors.forename: Véronique
authors.initials: V
authors.lastname: Brulotte
authors.forename: François A
authors.initials: FA
authors.lastname: Leblond
authors.forename: Stéphane
authors.initials: S
authors.lastname: Elkouri
authors.forename: Eric
authors.initials: E
authors.lastname: Thérasse
authors.forename: Vincent
authors.initials: V
authors.lastname: Pichette
authors.forename: Pierre
authors.initials: P
authors.lastname: Beaulieu