Prevention of contrast-induced nephropathy: A randomized controlled trial of sodium bicarbonate and N-acetylcysteine

Justin A. Ratcliffe, Prashan Thiagarajah, Jennifer Chen, Gita Kavala, Yumiko Kanei, John Fox, Ramesh Gowda, Sabrina J. Schmitz, Patricia Friedmann, Steven Bergmann

Research output: Contribution to journalArticle

11 Citations (Scopus)

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 (NaHCO3) alone or IV 0.9% NaHCO3 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 NaHCO3 only group and 4% in the NaHCO 3/NAC group (P=0.86). The maximum increase in serum creatinine was 14.14±12.38 mol/L in the NaHCO3 group, 10.60±29.14 mol/L in the NaCl only group, 9.72±13.26 mol/L in the NaCl/NAC group and 0.177±15.91 mol/L for the NaHCO3/ NAC group (P=0.0792). CONCLUSION: 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 NaHCO3 and/or NAC did not have an effect on the incidence of CIN.

Original languageEnglish (US)
Pages (from-to)193-197
Number of pages5
JournalInternational Journal of Angiology
Volume18
Issue number4
DOIs
StatePublished - Dec 2009

Fingerprint

Sodium Bicarbonate
Acetylcysteine
Randomized Controlled Trials
Incidence
Creatinine
Coronary Angiography
Serum
Acute Kidney Injury
Contrast Media
Renal Insufficiency
Diabetes Mellitus
Maintenance

Keywords

  • Cardiac catheterization
  • Contrast-induced nephropathy
  • N-acetylcysteine
  • Prevention
  • Sodium bicarbonate

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Prevention of contrast-induced nephropathy : A randomized controlled trial of sodium bicarbonate and N-acetylcysteine. / Ratcliffe, Justin A.; Thiagarajah, Prashan; Chen, Jennifer; Kavala, Gita; Kanei, Yumiko; Fox, John; Gowda, Ramesh; Schmitz, Sabrina J.; Friedmann, Patricia; Bergmann, Steven.

In: International Journal of Angiology, Vol. 18, No. 4, 12.2009, p. 193-197.

Research output: Contribution to journalArticle

Ratcliffe, JA, Thiagarajah, P, Chen, J, Kavala, G, Kanei, Y, Fox, J, Gowda, R, Schmitz, SJ, Friedmann, P & Bergmann, S 2009, 'Prevention of contrast-induced nephropathy: A randomized controlled trial of sodium bicarbonate and N-acetylcysteine', International Journal of Angiology, vol. 18, no. 4, pp. 193-197. https://doi.org/10.1055/s-0031-1278353
Ratcliffe, Justin A. ; Thiagarajah, Prashan ; Chen, Jennifer ; Kavala, Gita ; Kanei, Yumiko ; Fox, John ; Gowda, Ramesh ; Schmitz, Sabrina J. ; Friedmann, Patricia ; Bergmann, Steven. / Prevention of contrast-induced nephropathy : A randomized controlled trial of sodium bicarbonate and N-acetylcysteine. In: International Journal of Angiology. 2009 ; Vol. 18, No. 4. pp. 193-197.
@article{0974df30e2824c42aef7290ea7ddbdc0,
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 (NaHCO3) alone or IV 0.9{\%} NaHCO3 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 NaHCO3 only group and 4{\%} in the NaHCO 3/NAC group (P=0.86). The maximum increase in serum creatinine was 14.14±12.38 mol/L in the NaHCO3 group, 10.60±29.14 mol/L in the NaCl only group, 9.72±13.26 mol/L in the NaCl/NAC group and 0.177±15.91 mol/L for the NaHCO3/ NAC group (P=0.0792). CONCLUSION: 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 NaHCO3 and/or NAC did not have an effect on the incidence of CIN.",
keywords = "Cardiac catheterization, Contrast-induced nephropathy, N-acetylcysteine, Prevention, Sodium bicarbonate",
author = "Ratcliffe, {Justin A.} and Prashan Thiagarajah and Jennifer Chen and Gita Kavala and Yumiko Kanei and John Fox and Ramesh Gowda and Schmitz, {Sabrina J.} and Patricia Friedmann and Steven Bergmann",
year = "2009",
month = "12",
doi = "10.1055/s-0031-1278353",
language = "English (US)",
volume = "18",
pages = "193--197",
journal = "International Journal of Angiology",
issn = "1061-1711",
publisher = "Thieme Medical Publishers",
number = "4",

}

TY - JOUR

T1 - Prevention of contrast-induced nephropathy

T2 - A randomized controlled trial of sodium bicarbonate and N-acetylcysteine

AU - Ratcliffe, Justin A.

AU - Thiagarajah, Prashan

AU - Chen, Jennifer

AU - Kavala, Gita

AU - Kanei, Yumiko

AU - Fox, John

AU - Gowda, Ramesh

AU - Schmitz, Sabrina J.

AU - Friedmann, Patricia

AU - Bergmann, Steven

PY - 2009/12

Y1 - 2009/12

N2 - 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 (NaHCO3) alone or IV 0.9% NaHCO3 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 NaHCO3 only group and 4% in the NaHCO 3/NAC group (P=0.86). The maximum increase in serum creatinine was 14.14±12.38 mol/L in the NaHCO3 group, 10.60±29.14 mol/L in the NaCl only group, 9.72±13.26 mol/L in the NaCl/NAC group and 0.177±15.91 mol/L for the NaHCO3/ NAC group (P=0.0792). CONCLUSION: 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 NaHCO3 and/or NAC did not have an effect on the incidence of CIN.

AB - 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 (NaHCO3) alone or IV 0.9% NaHCO3 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 NaHCO3 only group and 4% in the NaHCO 3/NAC group (P=0.86). The maximum increase in serum creatinine was 14.14±12.38 mol/L in the NaHCO3 group, 10.60±29.14 mol/L in the NaCl only group, 9.72±13.26 mol/L in the NaCl/NAC group and 0.177±15.91 mol/L for the NaHCO3/ NAC group (P=0.0792). CONCLUSION: 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 NaHCO3 and/or NAC did not have an effect on the incidence of CIN.

KW - Cardiac catheterization

KW - Contrast-induced nephropathy

KW - N-acetylcysteine

KW - Prevention

KW - Sodium bicarbonate

UR - http://www.scopus.com/inward/record.url?scp=80053040861&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=80053040861&partnerID=8YFLogxK

U2 - 10.1055/s-0031-1278353

DO - 10.1055/s-0031-1278353

M3 - Article

C2 - 22477552

AN - SCOPUS:80053040861

VL - 18

SP - 193

EP - 197

JO - International Journal of Angiology

JF - International Journal of Angiology

SN - 1061-1711

IS - 4

ER -