Do intravenous N-acetylcysteine and sodium bicarbonate prevent high osmolal contrast-induced acute kidney injury? A randomized controlled trial

N-acetylcysteine (NAC) or sodium bicarbonate (NaHCO3), singly or combined, inconsistently prevent patients exposed to radiographic contrast media from developing contrast-induced acute kidney injury (CI-AKI). We asked whether intravenous isotonic saline and either NaHCO3 in 5% dextrose or else a hig...

Full description

Saved in:
Bibliographic Details
Published in:PloS one 2014-09, Vol.9 (9), p.e107602
Main Authors: Inda-Filho, Antonio Jose, Caixeta, Adriano, Manggini, Marcia, Schor, Nestor
Format: Article
Language:English
Subjects:
Acetylcysteine
Acetylcysteine - administration & dosage
Acetylcysteine - pharmacology
Acute Kidney Injury - chemically induced
Acute Kidney Injury - prevention & control
Administration, Intravenous
Angiography
Bicarbonates
Biology and Life Sciences
Biomarkers
Carbonates
Clinical medicine
Clinical trials
Contrast agents
Contrast media
Contrast Media - adverse effects
Contrast Media - chemistry
Core curriculum
Coronary Angiography - adverse effects
Creatinine
Cystatin C
Dextrose
Diabetes mellitus
Disease prevention
Drug dosages
Drugs
Exposure
Female
Glucose
Humans
Hydration
Hypertension
Hypotheses
Incidence
Injury prevention
Intravenous administration
Iothalamic Acid - adverse effects
Iothalamic Acid - analogs & derivatives
Iothalamic Acid - chemistry
Kidney diseases
Male
Medical imaging
Medicine and Health Sciences
Middle Aged
Nephrology
Osmolar Concentration
Patients
Randomization
Renal function
Research and Analysis Methods
Sodium
Sodium bicarbonate
Sodium Bicarbonate - administration & dosage
Sodium Bicarbonate - pharmacology
Studies
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:N-acetylcysteine (NAC) or sodium bicarbonate (NaHCO3), singly or combined, inconsistently prevent patients exposed to radiographic contrast media from developing contrast-induced acute kidney injury (CI-AKI). We asked whether intravenous isotonic saline and either NaHCO3 in 5% dextrose or else a high dose of NAC in 5% dextrose prevent CI-AKI in outpatients exposed to high-osmolal iodinated contrast medium more than does saline alone. This completed prospective, parallel, superiority, open-label, controlled, computer-randomized, single-center, Brazilian trial (NCT01612013) hydrated 500 adult outpatients (214 at high risk of developing CI-AKI) exposed to ioxitalamate during elective coronary angiography and ventriculography. From 1 hour before through 6 hours after exposure, 126 patients (group 1) received a high dose of NAC and saline, 125 (group 2) received NaHCO3 and saline, 124 (group 3) received both treatments, and 125 (group 4) received only saline. Groups were similar with respect to age, gender, weight, pre-existing renal dysfunction, hypertension, medication, and baseline serum creatinine and serum cystatin C, but diabetes mellitus was significantly less prevalent in group 1. CI-AKI incidence 72 hours after exposure to contrast medium was 51.4% (257/500), measured as serum creatinine > (baseline+0.3 mg/dL) and/or serum cystatin C > (1.1 · baseline), and 7.6% (38/500), measured as both serum creatinine and serum cystatin C > (baseline+0.3 mg/dL) or > (1.25 · baseline). CI-AKI incidence measured less sensitively was similar among groups. Measured more sensitively, incidence in group 1 was significantly (p
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0107602