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

Recio-Mayoral, Alejandro; Chaparro, Marinela; Prado, Belén; León, Rocío Cózar; Méndez, Irene; Banerjee, Debasish; Kaski, Juan Carlos; Cubero, José M.; Cruz, Jurandir Ferreira da

doi:10.1016/j.jacc.2006.11.034

Cited by 237 publications

(165 citation statements)

References 33 publications

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“…Posterior studies evaluated sodium bicarbonate in the prevention of CIN in patients submitted to the angiography and/or PCI produced conflicting results [17][18][19][20][21][22][23] . Some of these studies evaluated the use of sodium bicarbonate plus N-acetylcysteine 17,19,21,23 and, therefore, do not allow for a definitive conclusion regarding the benefit of isolated sodium bicarbonate in CIN prophylaxis, once the evaluation of two drugs simultaneously is an important confusion bias.…”

Section: Discussionmentioning

confidence: 99%

“…Some of these studies evaluated the use of sodium bicarbonate plus N-acetylcysteine 17,19,21,23 and, therefore, do not allow for a definitive conclusion regarding the benefit of isolated sodium bicarbonate in CIN prophylaxis, once the evaluation of two drugs simultaneously is an important confusion bias. Among studies that compared only sodium bicarbonate and saline solution, the results are also inconsistent 18,20,22 .…”

Section: Discussionmentioning

confidence: 99%

“…However, there is limited and controversial data regarding assessing the efficacy of sodium bicarbonate in patients undergoing cardiac catheterization [17][18][19][20][21][22][23] .…”

Section: Introductionmentioning

confidence: 99%

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Hidratação com bicarbonato de sódio não previne a nefropatia de contraste: ensaio clínico multicêntrico

Gomes

Lasevitch

Lima

et al. 2012

Arq. Bras. Cardiol.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Hidratação com bicarbonato de sódio não previne a nefropatia de contraste: ensaio clínico multicêntrico

Gomes

Lasevitch

Lima

et al. 2012

Arq. Bras. Cardiol.

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“…Of these, 14 randomized trials, including 2290 patients, compared sodium bicarbonate with sodium chloride for the prevention of CI-AKI and satisfied our selection criteria. Eight trials have been published (7,8,(15)(16)(17)(18)(19)(20) and six remain unpublished (21)(22)(23)(24)(25)(26)(27). The unpublished studies were identified in abstract form.…”

Section: Eligible Studiesmentioning

confidence: 99%

“…In this study, both groups were given sodium chloride at the same rate pre-and postcontrast exposure; however, the sodium bicarbonate group received a single 20-mEq bolus of sodium bicarbonate immediately before contrast exposure. All other trials identified in the systematic review administered sodium bicarbonate as an infusion of at least 5 h. The study by Recio-Mayoral was also excluded from the analysis (20). In this trial, the sodium bicarbonate group received more volume than the sodium chloride group (20).…”

Section: Eligible Studiesmentioning

confidence: 99%

Sodium Bicarbonate for the Prevention of Contrast Induced-Acute Kidney Injury

Brar

Hiremath

Dangas

et al. 2009

Clinical Journal of the American Society of Nephrology

158

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Background and objectives: Infusion of sodium bicarbonate has been suggested as a preventative strategy but reports are conflicting on its efficacy. The aim of this study was to assess the effectiveness of hydration with sodium bicarbonate for the prevention of contrast-induced acute kidney injury (CI-AKI).Design, setting, participants, & measurements: Medline, EMBASE, Cochrane library, and the Internet were searched for randomized controlled trials comparing hydration between sodium bicarbonate and chloride for the prevention of CI-AKI between 1966 and November 2008. Fourteen trials that included 2290 patients were identified. There was significant heterogeneity between studies (P heterogeneity ‫؍‬ 0.02; I 2 ‫؍‬ 47.8%), which was largely accounted for by trial size (P ‫؍‬ 0.016). Trials were therefore classified by size.Results: Three trials were categorized as large (n ‫؍‬ 1145) and 12 as small (n ‫؍‬ 1145). Among the large trials, the incidence of CI-AKI for sodium bicarbonate and sodium chloride was 10.7 and 12.5%, respectively; the relative risk (RR) [95% confidence interval (CI)] was 0.85 (0.63 to 1.16) without evidence of heterogeneity (P ‫؍‬ 0.89, I2 ‫؍‬ 0%). The pooled RR (95% CI) among the 12 small trials was 0.50 (0.27 to 0.93) with significant between-trial heterogeneity (P ‫؍‬ 0.01; I 2 ‫؍‬ 56%). The small trials were more likely to be of lower methodological quality.Conclusions: A significant clinical and statistical heterogeneity was observed that was largely explained by trial size and published status. Among the large randomized trials there was no evidence of benefit for hydration with sodium bicarbonate compared with sodium chloride for the prevention of CI-AKI. The benefit of sodium bicarbonate was limited to small trials of lower methodological quality.

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Prevention, Incidence, and Outcomes of Contrast-Induced Acute Kidney Injury

Weisbord

Mor²,

Resnick³

et al. 2008

Arch Intern Med

113

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Background: Little is known about whether health care providers (physicians) implement preventive care for contrast-induced acute kidney injury (CIAKI). The objectives of our prospective cohort study were (1) to assess provider use of preventive strategies for CIAKI, (2) to determine the incidence of CIAKI, and (3) to examine the association of CIAKI with adverse outcomes at 30 days, including death, need for dialysis, and hospital admission. Methods: We prospectively identified patients with estimated glomerular filtration rates less than 60 mL/min/ 1.73 m 2 undergoing procedures with intravascular radiocontrast agents and recorded the use of intravenous fluids and N-acetylcysteine and the discontinuation of nonsteroidal anti-inflammatory medications. We measured postprocedure serum creatinine levels to quantify the incidence of CIAKI and tracked 30-day mortality and need for dialysis or hospitalization to evaluate the association of CIAKI with these outcomes. Results: Preprocedure and postprocedure intravenous fluids were administered to 264 of 660 study patients (40.0%), more commonly with coronary angiography than with computed tomography (91.2% vs 16.6%, PϽ.001). N-acetylcysteine was administered to 39.2% of patients, while only 6.8% of patients using nonsteroidal antiinflammatorydrugswereinstructedtodiscontinuethemedication. In a propensity analysis, the use of intravenous fluids was associated with a reduced rate of CIAKI. The incidence of CIAKI was lowest following computed tomography (range, 0.0%-10.9%) and was highest following noncoronary angiography (range, 1.9%-34.0%). Eleven patients (1.7%) died, 1 patient (0.2%) required dialysis, and 83 patients (12.6%) were hospitalized; however, CIAKI was not independently associated with hospital admission or death. Conclusions: Strategies to prevent CIAKI are implemented nonuniformly. Although biochemical evidence of CIAKI is relatively common, clinically significant CIAKI is rare. These findings should help health care providers focus the use of preventive care on the highest-risk patients and have important implications for future clinical trials.

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

Abstract: 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.

Cited by 237 publications

References 33 publications

Hidratação com bicarbonato de sódio não previne a nefropatia de contraste: ensaio clínico multicêntrico

Hidratação com bicarbonato de sódio não previne a nefropatia de contraste: ensaio clínico multicêntrico

Sodium Bicarbonate for the Prevention of Contrast Induced-Acute Kidney Injury

Prevention, Incidence, and Outcomes of Contrast-Induced Acute Kidney Injury

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