CLINICAL RESEARCH: CLINICAL TRIAL
The Reno-Protective Effect of Hydration With Sodium Bicarbonate Plus N-Acetylcysteine in Patients Undergoing Emergency Percutaneous Coronary InterventionThe RENO Study
Alejandro Recio-Mayoral, MD*,*,
Marinela Chaparro, MD*,
Belén Prado, MD*,
Rocío Cózar, MD*,
Irene Méndez, MD*,
Debasish Banerjee, MD, MRCP ,
Juan C. Kaski, MD, DM, DSc ,
José Cubero, MD* and
Jose M. Cruz, MD*
* Department of Cardiology, Virgen Macarena University Hospital, Seville, Spain
Department of Renal and Transplantation
Division of Cardiac and Vascular Sciences, St. George's Hospital, University of London, London, United Kingdom
Manuscript received August 16, 2006;
revised manuscript received November 1, 2006,
accepted November 16, 2006.
* Reprint requests and correspondence: Dr. Alejandro Recio-Mayoral, Division of Cardiac and Vascular Sciences, St. George's Hospital, University of London, Cranmer Terrace, London SW17 0RE, United Kingdom. (Email: arecio{at}sgul.ac.uk).
Objectives: This study was designed to determine the effectiveness of a protocol for rapid intravenous hydration to prevent contrast-induced nephropathy (CIN) in patients undergoing emergency percutaneous coronary intervention (PCI).
Background: Contrast-induced nephropathy frequently complicates PCI, resulting in prolonged hospitalization and increased in-hospital and long-term morbidity and mortality. Little is known regarding prevention of CIN in patients undergoing urgent PCI.
Methods: We conducted a prospective, controlled, randomized, single-center trial in 111 consecutive patients with acute coronary syndrome undergoing emergency PCI. As part of the hydration therapy, 56 patients (group A) received an infusion of sodium bicarbonate plus N-acetylcysteine (N-AC) started just before contrast injection and continued for 12 h after PCI. The remaining 55 patients (group B) received the standard hydration protocol consisting of intravenous isotonic saline for 12 h after PCI. In both groups, 2 doses of oral N-AC were administered the next day.
Results: The 2 groups were similar with respect to age, gender, diabetes mellitus, and baseline serum creatinine. A serum creatinine concentration >0.5 mg/dl from baseline after emergency PCI was observed in 1 patient in group A (1.8%) and in 12 patients in group B (21.8%; p < 0.001). Acute anuric renal failure was observed in 1 patient (1.8%) in group A and in 7 patients (12.7%) in group B (p = 0.032).
Conclusions: Rapid intravenous hydration with sodium bicarbonate plus N-AC before contrast injection is effective and safe in the prevention of CIN in patients undergoing emergency PCI.
|
Abbreviations and Acronyms
| | ACS = acute coronary syndrome | | BUN = blood urea nitrogen | | CI = confidence interval | | CIN = contrast-induced nephropathy | | GFR = glomerular filtration rate | | N-AC = N-acetylcysteine | | OR = odds ratio | | PCI = percutaneous coronary intervention | | SCr = serum creatinine |
|
Related Article
-
Inside This Issue of JACC
J. Am. Coll. Cardiol. 2007 49: A33-A34.
[Full Text]
[PDF]
This article has been cited by other articles:
|
|
|
|
 
T. Klima, A. Christ, I. Marana, S. Kalbermatter, H. Uthoff, E. Burri, S. Hartwiger, C. Schindler, T. Breidthardt, G. Marenzi, et al.
Sodium chloride vs. sodium bicarbonate for the prevention of contrast medium-induced nephropathy: a randomized controlled trial
Eur. Heart J.,
January 19, 2012;
(2012)
ehr501v1.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. Marenzi, C. Ferrari, I. Marana, E. Assanelli, M. De Metrio, G. Teruzzi, F. Veglia, F. Fabbiocchi, P. Montorsi, and A. L. Bartorelli
Prevention of Contrast Nephropathy by Furosemide With Matched Hydration: The MYTHOS (Induced Diuresis With Matched Hydration Compared to Standard Hydration for Contrast Induced Nephropathy Prevention) Trial
J. Am. Coll. Cardiol. Intv.,
January 1, 2012;
5(1):
90 - 97.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Maioli, A. Toso, M. Leoncini, C. Micheletti, and F. Bellandi
Effects of Hydration in Contrast-Induced Acute Kidney Injury After Primary Angioplasty: A Randomized, Controlled Trial
Circ Cardiovasc Interv,
October 1, 2011;
4(5):
456 - 462.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. M. Anderson, Z. H. Park, and R. V. Patel
Intravenous N-Acetylcysteine in the Prevention of Contrast Media-Induced Nephropathy
Ann. Pharmacother.,
January 1, 2011;
45(1):
101 - 107.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Hiremath and S. S. Brar
The evidence for sodium bicarbonate therapy for contrast-associated acute kidney injury: far from settled science
Nephrol. Dial. Transplant.,
August 1, 2010;
25(8):
2802 - 2804.
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. Seeliger, K. Becker, M. Ladwig, T. Wronski, P. B. Persson, and B. Flemming
Up to 50-fold Increase in Urine Viscosity with Iso-osmolar Contrast Media in the Rat
Radiology,
August 1, 2010;
256(2):
406 - 414.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. Brochard, F. Abroug, M. Brenner, A. F. Broccard, R. L. Danner, M. Ferrer, F. Laghi, S. Magder, L. Papazian, P. Pelosi, et al.
An Official ATS/ERS/ESICM/SCCM/SRLF Statement: Prevention and Management of Acute Renal Failure in the ICU Patient: An International Consensus Conference in Intensive Care Medicine
Am. J. Respir. Crit. Care Med.,
May 15, 2010;
181(10):
1128 - 1155.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. J. Wiedermann and M. Joannidis
Increasing evidence base for sodium bicarbonate therapy to prevent contrast media-induced acute kidney injury: little role of unpublished studies
Nephrol. Dial. Transplant.,
March 1, 2010;
25(3):
650 - 654.
[Full Text]
[PDF]
|
|
|
|
|
|
|
Z. H. Endre and J. W. Pickering
Outcome definitions in non-dialysis intervention and prevention trials in acute kidney injury (AKI)
Nephrol. Dial. Transplant.,
January 1, 2010;
25(1):
107 - 118.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. Widimsky and I. Rychlik
Renal disease and acute coronary syndrome
Heart,
January 1, 2010;
96(1):
86 - 92.
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Zoungas, T. Ninomiya, R. Huxley, A. Cass, M. Jardine, M. Gallagher, A. Patel, A. Vasheghani-Farahani, G. Sadigh, and V. Perkovic
Systematic Review: Sodium Bicarbonate Treatment Regimens for the Prevention of Contrast-Induced Nephropathy
Ann Intern Med,
November 3, 2009;
151(9):
631 - 638.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. R. Brown, C. A. Block, D. J. Malenka, G. T. O'Connor, A. C. Schoolwerth, and C. A. Thompson
Sodium Bicarbonate Plus N-Acetylcysteine Prophylaxis: A Meta-Analysis
J. Am. Coll. Cardiol. Intv.,
November 1, 2009;
2(11):
1116 - 1124.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. S. Brar, S. Hiremath, G. Dangas, R. Mehran, S. K. Brar, and M. B. Leon
Sodium Bicarbonate for the Prevention of Contrast Induced-Acute Kidney Injury: A Systematic Review and Meta-analysis
Clin. J. Am. Soc. Nephrol.,
October 1, 2009;
4(10):
1584 - 1592.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. Marenzi, E. Assanelli, J. Campodonico, G. Lauri, I. Marana, M. De Metrio, M. Moltrasio, M. Grazi, M. Rubino, F. Veglia, et al.
Contrast Volume During Primary Percutaneous Coronary Intervention and Subsequent Contrast-Induced Nephropathy and Mortality
Ann Intern Med,
February 3, 2009;
150(3):
170 - 177.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
W. Burgess, G. J. Merten, and R. A. Rittase
Sodium Bicarbonate vs Sodium Chloride in Preventing Contrast Medium-Induced Nephropathy
JAMA,
January 28, 2009;
301(4):
377 - 377.
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. S. Brar, A. Y.-J. Shen, and M. B. Jorgensen
Sodium Bicarbonate vs Sodium Chloride in Preventing Contrast Medium-Induced Nephropathy--Reply
JAMA,
January 28, 2009;
301(4):
379 - 380.
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Bouzas-Mosquera, J. M. Vazquez-Rodriguez, and J. Peteiro
Sodium Bicarbonate vs Sodium Chloride in Preventing Contrast Medium-Induced Nephropathy
JAMA,
January 28, 2009;
301(4):
378 - 379.
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. A. Herzog
Kidney disease in cardiology
Nephrol. Dial. Transplant.,
January 1, 2009;
24(1):
34 - 37.
[Full Text]
[PDF]
|
|
|
|
|
|
|
N. Lameire, W. Van Biesen, E. Hoste, and R. Vanholder
The prevention of acute kidney injury: an in-depth narrative review Part 1: volume resuscitation and avoidance of drug- and nephrotoxin-induced AKI
Clinical Kidney Journal,
December 1, 2008;
1(6):
392 - 402.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Maioli, A. Toso, M. Leoncini, M. Gallopin, D. Tedeschi, C. Micheletti, and F. Bellandi
Sodium Bicarbonate Versus Saline for the Prevention of Contrast-Induced Nephropathy in Patients With Renal Dysfunction Undergoing Coronary Angiography or Intervention
J. Am. Coll. Cardiol.,
August 19, 2008;
52(8):
599 - 604.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. A. Baumgarten and J. H. Ellis
Contrast-Induced Nephropathy: Contrast Material Not Required?
Am. J. Roentgenol.,
August 1, 2008;
191(2):
383 - 386.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. D. Weisbord, M. K. Mor, A. L. Resnick, K. C. Hartwig, A. F. Sonel, M. J. Fine, and P. M. Palevsky
Prevention, Incidence, and Outcomes of Contrast-Induced Acute Kidney Injury
Arch Intern Med,
June 23, 2008;
168(12):
1325 - 1332.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. R. Dixon, C. L. Grines, and W. W. O'Neill
The Year in Interventional Cardiology
J. Am. Coll. Cardiol.,
June 17, 2008;
51(24):
2355 - 2369.
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. N. DeMaria, J. J. Bax, O. Ben-Yehuda, P. Clopton, G. K. Feld, G. S. Ginsburg, B. H. Greenberg, J. D. Knoke, W. Y.W. Lew, J. A.C. Lima, et al.
Highlights of the Year in JACC 2007
J. Am. Coll. Cardiol.,
January 29, 2008;
51(4):
490 - 512.
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. X. Garg, T. Greene, and N. W. Levin
A well-conducted randomized trial that establishes no benefit of therapy is an important medical advance
Nephrol. Dial. Transplant.,
January 1, 2008;
23(1):
52 - 55.
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. M. From, B. J. Bartholmai, A. W. Williams, S. S. Cha, A. Pflueger, and F. S. McDonald
Sodium Bicarbonate is Associated with an Increased Incidence of Contrast Nephropathy: A Retrospective Cohort Study of 7977 Patients at Mayo Clinic
Clin. J. Am. Soc. Nephrol.,
January 1, 2008;
3(1):
10 - 18.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. D. Weisbord and P. M. Palevsky
Prevention of Contrast-Induced Nephropathy with Volume Expansion
Clin. J. Am. Soc. Nephrol.,
January 1, 2008;
3(1):
273 - 280.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
