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Comparison between three supportive treatments for prevention of contrast-induced nephropathy in high-risk patients
Mohammad Reza Yeganehkhah, Leili Iranirad, Farshad Dorri
1Department of Internal Medicine, Clinical Research Development Center, Qom University of Medical Sciences, Qom, Iran.
Insights
Sodium bicarbonate infusion may be the preferred treatment for preventing contrast-induced nephropathy in high-risk patients. This study found it led to less significant serum creatinine increases compared to other methods.
Area of Science:
- Nephrology
- Cardiology
- Radiology
Background:
- Contrast-induced nephropathy (CIN) is a significant cause of acute kidney injury in hospitalized patients.
- Preventing CIN is crucial, especially in high-risk individuals undergoing procedures like coronary angiography.
Purpose of the Study:
- To compare the efficacy of Sodium Bicarbonate infusion, N-Acetylcysteine (NAC) plus Sodium Chloride (NaCl), and NaCl alone in preventing CIN.
- To identify the optimal supportive treatment for high-risk patients undergoing coronary angiography.
Main Methods:
- A randomized clinical trial involving 150 high-risk patients (e.g., diabetes, heart failure, age >65, renal insufficiency).
- Patients were divided into three groups receiving Sodium Bicarbonate, NAC+NaCl, or NaCl infusions.
- Serum creatinine, BUN, and urine pH were monitored before and 48 hours after Iohexol angiography.
Main Results:
- Serum creatinine levels increased significantly in the NaCl group (P=0.039) but not in the Sodium Bicarbonate or NAC+NaCl groups.
- The incidence of CIN was not statistically significant between the groups (P=0.944).
- Creatinine clearance was lower in the NaCl group, although not statistically significant.
Conclusions:
- Sodium Bicarbonate infusion appears to be a promising option for CIN prevention due to its effectiveness and potentially lower fluid volume and infusion time.
- Further research may solidify Sodium Bicarbonate as a preferred prophylactic agent for CIN in specific patient populations.
Abstract:
Contrast-induced nephropathy is the third most common cause of acute renal failure in hospitalized patients. The purpose of this study was to compare three supportive treatments for prevention of contrast-induced nephropathy in high-risk patients undergoing coronary angiography. In this randomized clinical trial study, 150 patients with at least one risk factor, such as, congestive heart failure, history of diabetes mellitus, age>65 years or renal failure were randomly assigned to three equal groups: First group (Sodium (Na) bicarbonate infusion), second group [(N-Acetylcysteine (NAC)+Sodium Chloride (Nacl)], third group (Nacl). Angiography was performed with 350 mgI/mL of Iohexol (Omnipaque). Serum creatinine (Cr), blood blood urea nitrogen (BUN), and urine pH were measured at the start of angiography and 48 hours later. The three groups had no significant difference in demographic characteristics or other risk factors before intervention (P>0.05). Forty eight hours after exposure, the Cr level increased significantly in the Nacl group (P=0.039), while these changes were not significant in the other groups (P>0.05). The incidence of contrast-induced nephropathy was not statistically significant between all the groups (P=0.944). Although the Cr clearance had no statistically significant difference, it was lower in the NaCl group. Therefore, Na bicarbonate may be the treatment of choice in the prevention of contrast-induced nephropathy, because of less prescribed fluid volume and a lesser time required for infusion of the fluid.
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