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CLINICAL RESEARCH: CLINICAL TRIAL

The Reno-Protective Effect of Hydration With Sodium Bicarbonate Plus N-Acetylcysteine in Patients Undergoing Emergency Percutaneous Coronary Intervention

The 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

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