N-Acetylcysteine added to volume expansion with sodium bicarbonate does not further prevent contrast-induced nephropathy: results from the cardiac angiography in renally impaired patients study
| Autor: | F.A.C.C. Samin K. Sharma M.D., Richard Solomon, Kanika P. Mody, Richard E. Katholi, Cezar S. Staniloae, Serge Doucet, John T. Coppola |
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| Rok vydání: | 2009 |
| Předmět: |
Male
medicine.medical_specialty Bicarbonate Urology Contrast-induced nephropathy Plasma Substitutes Renal function Buffers Coronary Angiography Nephropathy chemistry.chemical_compound Risk Factors Triiodobenzoic Acids medicine Humans Radiology Nuclear Medicine and imaging Aged Retrospective Studies Creatinine Sodium bicarbonate business.industry Free Radical Scavengers medicine.disease Iodixanol Surgery Acetylcysteine Iopamidol Sodium Bicarbonate chemistry Female Kidney Diseases Cardiology and Cardiovascular Medicine business medicine.drug Kidney disease Glomerular Filtration Rate |
| Zdroj: | Journal of interventional cardiology. 22(3) |
| ISSN: | 1540-8183 |
| Popis: | We reviewed data from the multicenter CARE (Cardiac Angiography in Renally Impaired Patients) study to see if benefit could be shown for N-acetylcysteine (NAC) in patients undergoing cardiac angiography who all received intravenous bicarbonate fluid expansion. Four hundred fourteen patients with moderate-to-severe chronic kidney disease were randomized to receive intra-arterial administration of iopamidol-370 or iodixanol-320. All patients were prehydrated with isotonic sodium bicarbonate solution. Each site chose whether or not to administer NAC 1,200 mg twice daily to all patients. Serum creatinine (SCr) levels and estimated glomerular filtration rate were assessed at baseline and 2-5 days after receiving contrast. The primary outcome was a postdose SCr increase 0.5 mg/dL (44.2 mumol/L) over baseline. Secondary outcomes were a postdose SCr increase 25% and the mean peak change in SCr. The NAC group received significantly less hydration (892 +/- 236 mL vs. 1016 +/- 328 mL; P < 0.001) and more contrast volume (146 +/- 74 mL vs. 127 +/- 71 mL; P = 0.009) compared with no-NAC group. SCr increases 0.5 mg/dL occurred in 4.2% (7 of 168 patients) in NAC group and 6.5% (16 of 246 patients) in no-NAC group (P = 0.38); rates of SCr increases 25% were 11.9% and 10.6%, respectively (P = 0.75); mean post-SCr increases were 0.07 mg/dL in NAC group versus 0.11 mg/dL in no-NAC group (P = 0.14). In conclusion, addition of NAC to fluid expansion with sodium bicarbonate failed to reduce the rate of contrast-induced nephropathy (CIN) after the intra-arterial administration of iopamidol or iodixanol to high-risk patients with chronic kidney disease. |
| Databáze: | OpenAIRE |
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