Premium
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
Author(s) -
Hafiz Abdul Moiz,
Jan M. Fuad,
Mori Naoyo,
Shaikh Fareed,
Wallach Jeffrey,
Bajwa Tanvir,
Allaqaband Suhail
Publication year - 2011
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.23148
Subject(s) - medicine , acute kidney injury , kidney disease , sodium bicarbonate , creatinine , incidence (geometry) , adverse effect , surgery , anesthesia , chemistry , physics , optics
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). Conclusion : 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. © 2011 Wiley Periodicals, Inc.