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

doi:10.1055/s-0031-1278353

International Journal of Angiology, Table of Contents

Int J Angiol 2009; 18(4): 193-197
DOI: 10.1055/s-0031-1278353

Original Article

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

Justin A. Ratcliffe¹ , Prashan Thiagarajah² , Jennifer Chen¹ , Gita Kavala² , Yumiko Kanei² , John Fox² , Ramesh Gowda² , Sabrina J. Schmitz, Patricia Friedmann² , Steven Bergmann²

¹Department of Medicine, Albert Einstein College of Medicine, Beth Israel Medical Center, New York, New York, USA
²Department of Cardiology, Albert Einstein College of Medicine, Beth Israel Medical Center, New York, New York, USA

Abstract

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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 NaHCO₃/NAC group (P=0.86). The maximum increase in serum creatinine was 14.14±12.38 μmol/L in the NaHCO₃ 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 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.

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