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Different interventions in preventing contrast-induced nephropathy after percutaneous coronary intervention

  • Nephrology - Original Paper
  • Published:
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Abstract

Background

This study aimed to observe the preventive potential of different hydration solutions on contrast-induced nephropathy (CIN) after percutaneous coronary intervention.

Methods

We initially screened 627 patients who were admitted to the Division of Cardiology, Beijing Anzhen Hospital between October 2010 and October 2011. The research subjects were randomly divided into four groups and were given: normal physiological saline (PS), sodium bicarbonate (SB), oral administration of PS + N-acetylcysteine (NAC) (PS + NAC), or oral administration of SB + NAC (SB + NAC). These patients were administered a hypotonic nonionic contrast agent, and the incidence of CIN in each group was observed.

Results

The total incidence rate of CIN was 4.47 %, while the CIN incidence rates in the PS group, the SB group, the PS + NAC group and the SB + NAC group were 3.11, 5.03, 4.46 and 5.33 %, respectively. The differences between these groups were not statistically significant (P = 0.238), and for patients with diabetes and/or renal dysfunction, the incidence rates of CIN among the four groups did not show statistically significant differences (P = 0.238, 0.156, 0.287).

Conclusion

Use of PS, SB, and NAC caused no significant reduction in the incidence of CIN, but in high-risk patients with diabetes and/or renal dysfunction, SB + NAC might be superior to the application of isotonic crystalloid solution.

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References

  1. Solomon RJ, Mehran R, Natarajan MK, Doucet S, Katholi RE, Staniloae CS, Sharma SK, Labinaz M, Gelormini JL, Barrett BJ (2009) Contrast-induced nephropathy and long-term adverse events: cause and effect? Clin J Am Soc Nephrol 4:1162–1169

    Article  PubMed Central  PubMed  Google Scholar 

  2. Liistro F, Falsini G, Bolognese L (2003) The clinical burden of contrast media-induced nephropathy. Ital Heart J 4:668–676

    PubMed  Google Scholar 

  3. Briguori C, Airoldi F, Morici N, Colombo A (2005) New pharmacological protocols to prevent or reduce contrast media nephropathy. Minerva Cardioangiol 53:49–58

    CAS  PubMed  Google Scholar 

  4. McCullough PA, Adam A, Becker CR, Davidson C, Lameire N, Stacul F, Tumlin J, CIN Consensus Working Panel (2006) Risk prediction of contrast-induced nephropathy. Am J Cardiol 98:27K–36K

    Article  PubMed  Google Scholar 

  5. Klima T, Christ A, Marana I, Kalbermatter S, Uthoff H, Burri E, Hartwiger S, Schindler C, Breidthardt T, Marenzi G, Mueller C (2012) Sodium chloride vs. sodium bicarbonate for the prevention of contrast medium-induced nephropathy: a randomized controlled trial. Eur Heart J 33:2071–2079

    Article  CAS  PubMed  Google Scholar 

  6. Kunadian V, Zaman A, Spyridopoulos I, Qiu W (2011) Sodium bicarbonate for the prevention of contrast induced nephropathy: a meta-analysis of published clinical trials. Eur J Radiol 79:48–55

    Article  PubMed  Google Scholar 

  7. Motohiro M, Kamihata H, Tsujimoto S, Seno T, Manabe K, Isono T, Sutani Y, Yuasa F, Iwasaka T (2011) A new protocol using sodium bicarbonate for the prevention of contrast-induced nephropathy in patients undergoing coronary angiography. Am J Cardiol 107:1604–1608

    Article  CAS  PubMed  Google Scholar 

  8. Adolph E, Holdt-Lehmann B, Chatterjee T, Paschka S, Prott A, Schneider H, Koerber T, Ince H, Steiner M, Schuff-Werner P, Nienaber CA (2008) Renal Insufficiency Following Radiocontrast Exposure Trial (REINFORCE): a randomized comparison of sodium bicarbonate versus sodium chloride hydration for the prevention of contrast-induced nephropathy. Coron Artery Dis 19:413–1419

    PubMed  Google Scholar 

  9. Koc F, Ozdemir K, Altunkas F, Celik A, Dogdu O, Karayakali M, Gul EE, Erkorkmaz U, Kadi H, Akpek M, Kaya MG (2013) Sodium bicarbonate versus isotonic saline for the prevention of contrast-induced nephropathy in patients with diabetes mellitus undergoing coronary angiography and/or intervention: a multicenter prospective randomized study. J Investig Med 61:872–877

    CAS  PubMed  Google Scholar 

  10. Wu MY, Hsiang HF, Wong CS, Yao MS, Li YW, Hsiang CY, Bai CH, Hsu YH, Lin YF, Tam KW (2013) The effectiveness of N-acetylcysteine in preventing contrast-induced nephropathy in patients undergoing contrast-enhanced computed tomography: a meta-analysis of randomized controlled trials. Int Urol Nephrol 45(5):1309–1318

    Article  CAS  PubMed  Google Scholar 

  11. Investigators ACT (2011) Acetylcysteine for prevention of renal outcomes in patients undergoing coronary and peripheral vascular angiography: main results from the randomized Acetylcysteine for Contrast-induced nephropathy Trial (ACT). Circulation 124:1250–1259

    Article  Google Scholar 

  12. Birck R, Krzossok S, Markowetz F, Schnülle P, van der Woude FJ, Braun C (2003) Acetylcysteine for prevention of contrast nephropathy: meta-analysis. Lancet 362:598–603

    Article  CAS  PubMed  Google Scholar 

  13. Staniloae CS, Doucet S, Sharma SK, Katholi RE, Mody KR, Coppola JT, Solomon R (2009) N-Acetylcysteine added to volume expansion with sodium bicarbonate does not further prevent contrast-induced nephropathy: results from the cardiac angiography in renally impaired patients study. J Interv Cardiol 22:261–265

    Article  PubMed  Google Scholar 

  14. Berwanger O, Cavalcanti AB, Sousa AM et al (2013) Acetylcysteine for the prevention of renal outcomes in patients with diabetes mellitus undergoing coronary and peripheral vascular angiography: a substudy of the acetylcysteine for contrast-induced nephropathy trial. Circ Cardiovasc Interv 6:139–145

    Article  CAS  PubMed  Google Scholar 

  15. Brown JR, Block CA, Malenka DJ, O’Connor GT, Schoolwerth AC, Thompson CA (2009) Sodium bicarbonate plus N-acetylcysteine prophylaxis: a meta-analysis. JACC Cardiovasc Interv 2:1116–1124

    Article  PubMed  Google Scholar 

  16. Lee SW, Kim WJ, Kim YH et al (2011) Preventive strategies of renal dysfunction in patients with diabetes undergoing intervention or arteriography (the PREVENT Trial). Am J Cardiol 107:1447–1452

    Article  PubMed  Google Scholar 

  17. Levine GN, Bates ER, Blankenship JC et al (2011) 2011 ACCF/AHA/SCAI guideline for percutaneous coronary intervention. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. J Am Coll Cardiol 58:e44–e122

    Article  PubMed  Google Scholar 

  18. Merten GJ, Burgess WP, Rittase RA, Kennedy TP (2004) Prevention of contrast-induced nephropathy with sodium bicarbonate: an evidence-based protocol. Crit Pathw Cardiol 3:138–143

    Article  PubMed  Google Scholar 

  19. Coyle LC, Rodriguez A, Jeschke RE, Simon-Lee A, Abbott KC, Taylor AJ (2006) Acetylcysteine in diabetes (AID): a randomized study of acetylcysteine for the prevention of contrast nephropathy in diabetics. Am Heart J 151:1032.e9–1032.e12

    Article  Google Scholar 

  20. Thomsen HS (2007) European Society of Urogenital Radiology guidelines on contrast media application. Curr Opin Urol 17:70–76

    Article  PubMed  Google Scholar 

  21. Ma YC, Zuo L, Chen JH et al (2006) Modified glomerular filtration rate estimating equation for Chinese patients with chronic kidney disease. J Am Soc Nephrol 17:2937–2944

    Article  PubMed  Google Scholar 

  22. National Kidney Foundation (2002) K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 39:S1–S266

    Google Scholar 

  23. Lameire N, Adam A, Becker CR, Davidson C, McCullough PA, Stacul F, Tumlin J, CIN Consensus Working Panel (2006) Baseline renal function screening. Am J Cardiol 98:21K–26K

    Article  PubMed  Google Scholar 

  24. Liu YH, Liu Y, Tan N, Chen JY, Chen J, Chen SH, He YT, Ran P, Ye P, Li Y (2014) Predictive value of GRACE risk scores for contrast-induced acute kidney injury in patients with ST-segment elevation myocardial infarction before undergoing primary percutaneous coronary intervention. Int Urol Nephrol 46(2):417–426

    Article  PubMed  Google Scholar 

  25. Svensson AS, Kovesdy CP, Kvitting JP, Rosén M, Cederholm I, Szabó Z (2013) Comparison of serum cystatin C and creatinine changes after cardiopulmonary bypass in patients with normal preoperative kidney function. Int Urol Nephrol 45(6):1597–1603

    Article  CAS  PubMed  Google Scholar 

  26. Li WH, Li DY, Han F, Xu TD, Zhang YB, Zhu H (2013) Impact of anemia on contrast-induced nephropathy (CIN) in patients undergoing percutaneous coronary interventions. Int Urol Nephrol 45(4):1065–1070

    Article  PubMed Central  PubMed  Google Scholar 

  27. Mueller C, Buerkle G, Buettner HJ, Petersen J, Perruchoud AP, Eriksson U, Marsch S, Roskamm H (2002) Prevention of contrast media-associated nephropathy: randomized comparison of 2 hydration regimens in 1620 patients undergoing coronary angioplasty. Arch Intern Med 162:329–336

    Article  CAS  PubMed  Google Scholar 

  28. Stacul F, van der Molen AJ, Reimer P, Webb JA, Thomsen HS, Morcos SK, Almén T, Aspelin P, Bellin MF, Clement O, Heinz-Peer G (2011) Contrast induced nephropathy: updated ESUR Contrast Media Safety Committee guidelines. Eur Radiol 21:2527–2541

    Article  PubMed  Google Scholar 

  29. Li WH, Li DY, Qian WH, Liu JL, Xu TD, Zhu H, He HY (2014) Prevention of contrast-induced nephropathy with prostaglandin E1 in high-risk patients undergoing percutaneous coronary intervention. Int Urol Nephrol 46(4):781–786

    Article  CAS  PubMed  Google Scholar 

  30. Miao Y, Zhong Y, Yan H, Li W, Wang BY, Jin J (2013) Alprostadil plays a protective role in contrast-induced nephropathy in the elderly. Int Urol Nephrol 45(4):1179–1185

    Article  PubMed  Google Scholar 

  31. Yavari V, Ostovan MA, Kojuri J, Afshariani R, Hamidian A, Roozbeh J, Pakfetrat M (2014) The preventive effect of pentoxifylline on contrast-induced nephropathy: a randomized clinical trial. Int Urol Nephrol 46(1):41–46

    Article  CAS  PubMed  Google Scholar 

  32. Firouzi A, Eshraghi A, Shakerian F, Sanati HR, Salehi N, Zahedmehr A, Kiani R, Madani M, Pedarzadeh A (2012) Efficacy of pentoxifylline in prevention of contrast-induced nephropathy in angioplasty patients. Int Urol Nephrol 44(4):1145–1149

    Article  CAS  PubMed  Google Scholar 

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Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Coronary Care Unit (CCU), Capital Medical University Affiliated Beijing Anzhen Hospital, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, 100029, China

    Kun Yang, Wenxian Liu, Wei Ren & Shuzheng Lv

  2. Department of Vasculocardiology, Capital Medical University Affiliated Beijing Anzhen Hospital, Beijing Institute of Heart, Lung and Blood Vessel Diseases, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China

    Shuzheng Lv

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  1. Kun Yang
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  2. Wenxian Liu
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Correspondence to Shuzheng Lv.

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Yang, K., Liu, W., Ren, W. et al. Different interventions in preventing contrast-induced nephropathy after percutaneous coronary intervention. Int Urol Nephrol 46, 1801–1807 (2014). https://doi.org/10.1007/s11255-014-0765-3

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  • DOI: https://doi.org/10.1007/s11255-014-0765-3

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