“CONTRAST” STUDY: COMPARİSİON OF NEPHROPROTECTİVE THREE PROTOCOLS: ACETYLCYSTEİNESODİUM BİCARBONATE-THEOPHYLLİNE, TO PREVENT CONTRAST-İNDUCED NEPHROPATHY

Baris Okcun,Tolga Dasli,Ilker Murat Caglar,Fatma Nihan Turhan Caglar,Faruk Akturk,Cenk Conkbayir,Murat Baskurt

doi:10.15829/1560-4071-2014-1-eng-27-31

Abstract

Aim. The purpose of this study was to compare three prophylactic regimens, sodium-bicarbonate based hydration, sodium-bicarbonate + N-acetylcysteine (NAC), and sodium-bicarbonate + NAC + theophylline, for the prevention of contrast induced nephropathy. Material and methods. We prospectively randomized 151 patients with baseline eGFR values between 30–59 ml/min/1.73m² who were also undergoing coronary angiography with three prophylactic treatments: intravenous hydration with sodiumbicarbonate (3 ml/kg/h for 1 hours before and 1 ml/kg/h for 6 hours after contrast exposure, group 1; n=50), hydration + NAC (600 mg p. o. twice daily the preceding day and the day of angiography, group 2; n=50), and hydration + NAC + theophylline (600 mg p. o. NAC and 200 mg theophylline p. o. twice daily for the preceding day and the day of angiography, group 3; n=51). The incidence of contrast induced nephropathy (0,5 mg/dl increase in serum creatinine from the baseline value 48 hours after intravascular injection of contrast) from the three groups was compared. Results. Of the 151 patients, 4 patients (7.8%) in group 3 experienced CIN (p=0.01). CIN did not develop in group 1 and 2. Conclusion. Among patients with eGFR values between 30–59 ml/min/1.73m² undergoing coronary angiography, use of sodium-bicarbonate based hydration alone and sodium-bicarbonate with NAC was associated with a reduction in the rate of contrast induced nephropathy. Sodium-bicarbonate with theophylline therapy was found to have no effect for the prevention of contrast-induced nephropathy.

Highlights

Cardiovascular diseases are increasingly becoming the major cause of morbidity and mortality worldwide [1, 2]
The GFR was estimated using the formula of modification of diet in renal disease (MDRD) Formula: MDRD formula: 186 x serum creatinine x age (For women multiple by 0.742) Calculations were made automatically from an on-line site, http://nkdep.nih.gov/professionals/gfr_calculators/ orig_con.htm site
Renal function tests (SCre and blood urea nitrogen (BUN) levels) were performed before the procedure, and they were similar among groups (Table 1)

Summary

Introduction

Cardiovascular diseases are increasingly becoming the major cause of morbidity and mortality worldwide [1, 2]. Coronary angiography (CAG) is the gold standard method for the diagnosis of coronary artery disease (CAD) [3,4,5]. CAG-related complications are rare (less than 1–2%) and contrast-induced nephropathy (CIN) is an important one that increases in-hospital and long-term morbidity and mortality as a result of acute and chronic renal failure [4]. CIN was first defined in 1960 and is the third leading cause of hospital-acquired acute renal failure [6,7,8]. CIN is defined as at least 0.5mg/dl or 25% increase in serum creatinin (SCre) levels 48 hours after contrast media exposure [6, 8, 9]. In- hospital mortality is 35.7%, and 1-year mortality is 55% in patients requiring dialysis [6,7,8,9]

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Conclusion