The Role of Saline and Sodium Bicarbonate Preprocedural Hydration to Prevent Mid-term Renal Insufficiency in Patients with Chronic Kidney Disease Undergoing Percutaneous Coronary Intervention

Hagikura, Arata; Goto, Kenji; Takebayashi, Hideo; Kikuta, Yuetsu; Kobayashi, K; Sato, Katsumasa; Taniguchi, Masahito; Hiramatsu, Shigeki; Kawai, Yu; Kohno, Hiroaki; Kusuyama, Takanori; Haruta, Seiichi

doi:10.2169/internalmedicine.1442-18

Cited by 3 publications

(4 citation statements)

References 26 publications

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“…31 Thus, early preventive measures such as statin, b-blockers, and hydration may be clinically relevant. [35][36][37] One advantage of our study was the use of different models including propensity score to adjust for potential confounders. 38 Nevertheless, our study has some limitations.…”

Section: Discussionmentioning

confidence: 99%

The Relationship Between AKI in Patients With STEMI and Short-Term Mortality: A Propensity Score Matching Analysis

et al. 2021

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Acute myocardial infarction (AMI) in patients with acute kidney injury (AKI) is associated with poor long-term outcome. However, the short-term prognosis of AKI in patients with ST-elevation AMI (STEMI) needs to be explored further. We assessed this relationship between these patients and short-term mortality in relation to AKI and chronic kidney disease (CKD). All data were extracted from the Medical Information Mart for Intensive Care III database. The primary outcome was 28-day mortality. Kaplan-Meier curves, logistic regression models, and propensity score matching analysis were used to evaluate the associations between AKI in patients with STEMI and outcomes. A total of 1031 patients with STEMI met the inclusion criteria. For 28-day mortality, in the multivariable logistic regression models, the odds ratio (95% CI) of group 2 (AKI but no CKD) and group 3 (AKI in the presence of CKD) were 3.24 (1.46-7.18) and 4.57 (1.83-11.37), respectively, compared with group 1 (no AKI and no CKD). Comorbid AKI increased the risk of short-term mortality among patients with STEMI, especially for those with AKI in the presence of CKD.

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Section: Discussionmentioning

confidence: 99%

The Relationship Between AKI in Patients With STEMI and Short-Term Mortality: A Propensity Score Matching Analysis

et al. 2021

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“…Another study conversely showed that there was increased CI-AKI in the sodium bicarbonate group [ 12 ]. Hagikura et al demonstrated there was no protective effect of intravenous sodium bicarbonate, but the normal saline group showed protective effects [ 29 ]. N-acetylcysteine (NAC) has been known as a potent antioxidant and may prevent direct oxidative kidney damage [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

Is It Safe to Do Percutaneous Coronary Intervention in Moderate to Severe Chronic Kidney Disease Patients? A Prospective Cohort Study

Santosa¹,

Harca²,

Yuwono³

et al. 2022

Cureus

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Introduction: Contrast-induced acute kidney injury (CI-AKI) is a common and potentially serious complication of percutaneous coronary intervention (PCI) procedures, as it induces acute kidney injury (AKI), especially in previously diagnosed chronic kidney disease (CKD) patients, particularly in those who also have diabetes. Adequate hydration and using a minimal volume of contrast media are the recommended measures to decrease CI-AKI in CKD patients. A combination of sodium bicarbonate and N-acetylcysteine (NAC) may be a superior strategy for preventing CI-AKI. This study is aimed to evaluate the safety of PCI in moderate to severe CKD patients.Method: This was a prospective, single-center study, from 2019 to 2021. We included all chronic kidney disease who undergo PCI procedures. The kidney level was measured on admission and 24 hours after the PCI procedure. The patients received 75 meq/500 mL of sodium bicarbonate one to six hours before procedures, oral acetylcysteine 600 mg bid for three days, and rehydration with 1000 ml of normal saline infusion for eight hours in patients without congestive heart failure. SPSS Version 23.0 (IBM SPSS Statistics for Windows, Version 23.0., IBM Corp., Armonk, NY) was used to input and process the data.Results: This study included 118 subjects, with baseline characteristics of age 58.77 ± 9.08 years, 80.5% male, 47.5% diabetic, 50% hypertension, and 59.5% congestive heart failure. From the coronary angiogram, we found most of our subjects (57.6%) had three-vessel disease, 28.8% had two-vessel disease, and 15.6% had one-vessel disease. About 67.8% of subjects used <50 ml of low molecular contrast. The baseline creatinine level was 2.46 ± 1.04 mg/dL and the estimated glomerular filtration rate (eGFR) was 30 ± 12.65 mL/min. There were 19 (16.1%) patients with stage 3A CKD, 45 (38.1%) stage 3B, 41 (34.7%) stage 4, and 41 (34.7%) stage 5. The kidney function test after 24 hours of contrast admission showed a creatinine level of 2.37 ± 1.20 mg/dL (P<0.05) and the eGFR of 34.74 ± 16.10 mL/min. There was no significant difference in creatinine levels between stage 3A and stage 5 CKD. There was a significant reduction in creatinine in stage 3B CKD, from 1.917 ± 0.22 to 1.71 ± 0.37 mg/dL (P = 0.001); and stage 4 CKD, from 2.77 ± 0.55 to 2.72 ± 0.94 mg/dL (P = 0.013).Discussion: CKD is a risk factor for developing CI-AKI after PCI, which is a marker of poor long-term outcomes. The development of CI-AKI is a strong predictor of post-PCI bleeding, which aggravates hemodynamic instability. The combination of NAC and NaHCO 3 exerts a better antioxidative effect, which reduces the harmful short-term and long-term consequences of contrast media. Previous studies revealed the use of low-to-zero contrast media was safer in CKD patients who had undergone PCI. By applying these measures, our study showed a good outcome of PCI with no worsening renal function in CKD patients.Conclusion: With good prophylaxis measures, such as using minimal volume contrast media, adequate rehydration, and the combi...

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“…Sodium bicarbonate hydration has been the subject of several recent randomized clinical trials and reviews. 8,9,17,[22][23][24][25][26][27][28] Weisbord et al 23 reported no benefit of periprocedural admin-istration of intravenous isotonic sodium bicarbonate over intravenous isotonic sodium chloride among patients with impaired kidney function undergoing angiography. Prehydration with 250 mL of sodium bicarbonate has previously been shown to be noninferior to prehydration with 1 L of saline and posthydration with 1 L of saline in the prevention of PC-AKI in a noninferiority trial conducted by our study group.…”

Section: Discussionmentioning

confidence: 99%

“…Sodium bicarbonate hydration has been the subject of several recent randomized clinical trials and reviews . Weisbord et al reported no benefit of periprocedural administration of intravenous isotonic sodium bicarbonate over intravenous isotonic sodium chloride among patients with impaired kidney function undergoing angiography.…”

Section: Discussionmentioning

confidence: 99%

Effect of No Prehydration vs Sodium Bicarbonate Prehydration Prior to Contrast-Enhanced Computed Tomography in the Prevention of Postcontrast Acute Kidney Injury in Adults With Chronic Kidney Disease

et al. 2020

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IMPORTANCE Prevention of postcontrast acute kidney injury in patients with stage 3 chronic kidney disease (CKD) by means of prehydration has been standard care for years. However, evidence for the need for prehydration in this group is limited.OBJECTIVE To assess the renal safety of omitting prophylactic prehydration prior to iodine-based contrast media administration in patients with stage 3 CKD. DESIGN, SETTING, AND PARTICIPANTSThe Kompas trial was a multicenter, noninferiority, randomized clinical trial conducted at 6 hospitals in the Netherlands in which 523 patients with stage 3 CKD were randomized in a 1:1 ratio to receive no prehydration or prehydration with 250 mL of 1.4% sodium bicarbonate administered in a 1-hour infusion before undergoing elective contrast-

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The Role of Saline and Sodium Bicarbonate Preprocedural Hydration to Prevent Mid-term Renal Insufficiency in Patients with Chronic Kidney Disease Undergoing Percutaneous Coronary Intervention

Cited by 3 publications

References 26 publications

The Relationship Between AKI in Patients With STEMI and Short-Term Mortality: A Propensity Score Matching Analysis

The Relationship Between AKI in Patients With STEMI and Short-Term Mortality: A Propensity Score Matching Analysis

Is It Safe to Do Percutaneous Coronary Intervention in Moderate to Severe Chronic Kidney Disease Patients? A Prospective Cohort Study

Effect of No Prehydration vs Sodium Bicarbonate Prehydration Prior to Contrast-Enhanced Computed Tomography in the Prevention of Postcontrast Acute Kidney Injury in Adults With Chronic Kidney Disease

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