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document
Sodium bicarbonate , N-acetylcysteine , and saline for prevention of radiocontrast-induced nephropathy . A comparison of 3 regimens for protecting contrast-induced nephropathy in patients undergoing coronary procedures . A single-center prospective controlled trial . BACKGROUND Several protective therapies have been developed to prevent contrast-induced nephropathy ( CIN ) . We aimed to investigate the efficacy of sodium bicarbonate by comparing 2 other regimens , including combination of N-acetylcysteine ( NAC ) plus sodium chloride and sodium chloride alone , to prevent CIN in patients undergoing cardiovascular procedures . METHODS We prospectively enrolled 264 patients who were scheduled for cardiovascular procedures and had a baseline creatinine level > 1.2 mg/dL . The patients were assigned 1 of 3 prophylactic regimens : infusion of sodium bicarbonate , sodium chloride , sodium chloride plus oral NAC ( 600 mg bid ) . Contrast-induced nephropathy was defined as an increase in serum creatinine level > 25 % or 0.5 mg/dL after 48 hours . RESULTS There were no significant differences among groups regarding baseline demographic properties and nephropathy risk factors . The change in creatinine clearance was significantly better in the sodium bicarbonate group than other 2 groups ( P = .007 ) . The incidence of CIN was significantly lower in the sodium bicarbonate group ( 4.5 % ) compared with sodium chloride alone ( 13.6 % , P = .036 ) and tended to be lower than in the combination group ( 12.5 % , P = .059 ) . After adjusting the Mehran nephropathy risk score , the risk of CIN significantly reduced with sodium bicarbonate compared with sodium chloride alone ( adjusted risk ratio 0.29 , P = .043 ) . CONCLUSIONS Hydration with sodium bicarbonate provides better protection against CIN than the sodium chloride infusion does alone . Combination therapy of NAC plus sodium chloride did not offer additional benefit over hydration with sodium chloride alone .
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Intervention_Pharmacological
Sodium bicarbonate
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Intervention_Pharmacological
N-acetylcysteine
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Intervention_Pharmacological
saline
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Intervention_Pharmacological
sodium bicarbonate
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Intervention_Pharmacological
combination of N-acetylcysteine ( NAC )
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Intervention_Pharmacological
sodium chloride
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Intervention_Pharmacological
sodium chloride
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Intervention_Pharmacological
sodium bicarbonate
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Intervention_Pharmacological
sodium chloride
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Intervention_Pharmacological
sodium chloride plus oral NAC
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Intervention_Pharmacological
sodium bicarbonate
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Intervention_Pharmacological
sodium bicarbonate
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Intervention_Pharmacological
sodium chloride
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Intervention_Pharmacological
combination
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Intervention_Pharmacological
sodium bicarbonate
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Intervention_Pharmacological
sodium chloride
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Intervention_Pharmacological
sodium bicarbonate
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Intervention_Pharmacological
sodium chloride
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Intervention_Pharmacological
Combination therapy of NAC plus sodium chloride
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Intervention_Pharmacological
sodium chloride alone
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Outcome_Physical
radiocontrast-induced nephropathy
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Outcome_Physical
contrast-induced nephropathy ( CIN ) .
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Outcome_Physical
Contrast-induced nephropathy
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Outcome_Physical
increase in serum creatinine level > 25 %
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Outcome_Physical
nephropathy
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Outcome_Adverse-effects
risk factors
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Outcome_Physical
.
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Outcome_Physical
change in creatinine clearance
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Outcome_Other
incidence of CIN
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Outcome_Other
Mehran nephropathy risk score
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Outcome_Other
risk of CIN
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Outcome_Physical
CIN
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Participant_Condition
radiocontrast-induced nephropathy .