Effectiveness of Prevention Strategies for Contrast-Induced Nephropathy

Subramaniam, Rathan M.; Suarez‐Cuervo, Catalina; Wilson, Renée F; Turban, Sharon; Zhang, Allen; Sherrod, Cheryl; Aboagye, Jonathan; Eng, John; Choi, Michael; Hutfless, Susan; Bass, Eric B.

doi:10.7326/m15-1456

Cited by 166 publications

(118 citation statements)

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“…Multiple previous trials and meta-analyses that have compared sodium bicarbonate with sodium chloride and evaluated acetylcysteine for the prevention of contrast-associated acute kidney injury have shown inconsistent results. [5][6][7][8][9][10][11]15,16 Despite equipoise regarding the effectiveness of these treatments, they are widely used in clinical prac- * Details regarding acute kidney injury and persistent kidney impairment are provided in Table 3, along with other trial end points. 0.64 * The primary end point was a composite of death, the need for dialysis, or a persistent increase of at least 50% from baseline in the serum creatinine level at 90 days.…”

Section: Discussionmentioning

confidence: 99%

“…4 On the basis of hypotheses that urinary alkalinization and scavenging of reactive oxygen species mitigate renal tubular epithelial-cell injury from the use of iodinated contrast material, multiple studies have compared intravenous sodium bicarbonate with intravenous sodium chloride and have evaluated treatment with acetylcysteine for the prevention of contrast-associated acute kidney injury, with inconsistent results. [5][6][7][8][9][10][11] Consequently, equipoise exists regarding these interventions, despite their widespread use in clinical practice. We designed the Prevention of Serious Adverse Events Following Angiography (PRESERVE) trial to compare intravenous sodium bicarbonate with intravenous sodium chloride and oral acetylcysteine with oral placebo for the prevention of major adverse outcomes and acute kidney injury in a large population of high-risk patients undergoing coronary or noncoronary angiography.…”

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Outcomes After Angiography With Sodium Bicarbonate and Acetylcysteine

Weisbord¹,

Gallagher²,

Jneid³

et al. 2018

Journal of Vascular Surgery

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BACKGROUNDIntravenous sodium bicarbonate and oral acetylcysteine are widely used to prevent acute kidney injury and associated adverse outcomes after angiography without definitive evidence of their efficacy. METHODSUsing a 2-by-2 factorial design, we randomly assigned 5177 patients at high risk for renal complications who were scheduled for angiography to receive intravenous 1.26% sodium bicarbonate or intravenous 0.9% sodium chloride and 5 days of oral acetylcysteine or oral placebo; of these patients, 4993 were included in the modified intention-to-treat analysis. The primary end point was a composite of death, the need for dialysis, or a persistent increase of at least 50% from baseline in the serum creatinine level at 90 days. Contrast-associated acute kidney injury was a secondary end point. RESULTSThe sponsor stopped the trial after a prespecified interim analysis. There was no interaction between sodium bicarbonate and acetylcysteine with respect to the primary end point (P = 0.33). The primary end point occurred in 110 of 2511 patients (4.4%) in the sodium bicarbonate group as compared with 116 of 2482 (4.7%) in the sodium chloride group (odds ratio, 0.93; 95% confidence interval [CI], 0.72 to 1.22; P = 0.62) and in 114 of 2495 patients (4.6%) in the acetylcysteine group as compared with 112 of 2498 (4.5%) in the placebo group (odds ratio, 1.02; 95% CI, 0.78 to 1.33; P = 0.88). There were no significant between-group differences in the rates of contrast-associated acute kidney injury. CONCLUSIONSAmong patients at high risk for renal complications who were undergoing angiography, there was no benefit of intravenous sodium bicarbonate over intravenous sodium chloride or of oral acetylcysteine over placebo for the prevention of death, need for dialysis, or persistent decline in kidney function at 90 days or for the prevention of contrast-associated acute kidney injury. (Funded by the U.S. Department of Veterans Affairs Office of Research and Development and the National Health and Medical Research Council of Australia; PRESERVE ClinicalTrials.gov number, NCT01467466.) a bs tr ac t

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Outcomes After Angiography With Sodium Bicarbonate and Acetylcysteine

Weisbord¹,

Gallagher²,

Jneid³

et al. 2018

Journal of Vascular Surgery

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“…La revue de Solomon et Segal, publiée dans ce numéro de Médecine Intensive et Réanimation [4], traite de l'intérêt de la diurèse forcée dans certaines pathologies et résume de façon exhaustive les résul-tats des derniers essais avec le RenalGuard ® en mettant en exergue le bénéfice de cette technique dans la prévention de l'insuffisance rénale aiguë associée aux produits de contraste iodés (IRAPC). L'incidence de l'IRAPC varie entre 2 et 25 % selon la définition usitée, le type et la quantité de produit de contraste injecté et les caractéristiques de la population étudiée [5]. Sa survenue est associée à un risque d'épuration extrarénale et de mortalité plus élevé, et à une prolongation de la durée de séjour à l'hôpital [5].…”

unclassified

“…L'incidence de l'IRAPC varie entre 2 et 25 % selon la définition usitée, le type et la quantité de produit de contraste injecté et les caractéristiques de la population étudiée [5]. Sa survenue est associée à un risque d'épuration extrarénale et de mortalité plus élevé, et à une prolongation de la durée de séjour à l'hôpital [5]. Parmi la multitude de mesures théra-peutiques proposées, seule l'hydratation par sérum salé isotonique a montré un réel bénéfice dans la prévention de l'IRAPC [5].…”

unclassified

“…Sa survenue est associée à un risque d'épuration extrarénale et de mortalité plus élevé, et à une prolongation de la durée de séjour à l'hôpital [5]. Parmi la multitude de mesures théra-peutiques proposées, seule l'hydratation par sérum salé isotonique a montré un réel bénéfice dans la prévention de l'IRAPC [5]. Toutefois, la réduction de la concentration tubulaire du toxique grâce au maintien d'un débit urinaire élevé demeure une option envisagée par certains auteurs dans l'arsenal thérapeutique.…”

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