Renin–angiotensin–aldosterone-system blockade and contrast-induced nephropathy

Abstract

I have read the article by Chong et al. [ [1] Chong Eric Poh Kian-Keong Lu Qingshu Zhang James Jun-Jie Tan Ning Hou Xu Min Ong Hean-Yee Azan Aizai Chen Shao-Liang Chen Ji-Yan Ali Rosli Mohd Fang Wei-Yi Lau Titus Wai Leong Tan Huay-Cheem Comparison of combination therapy of high-dose oral n-acetylcysteine and intravenous sodium bicarbonate hydration with individual therapies in the reduction of contrast-induced nephropathy during cardiac catheterisation and percutaneous coronary intervention (CONTRAST): a multi-centre, randomised, controlled trial. Int. J. Cardiol. 2015; 201: 237-242 Abstract Full Text Full Text PDF PubMed Scopus (27) Google Scholar ] with great interest, recently published online in your journal. In their study, the authors reported that the combination regimen was not superior to individual regimens in preventing contrast-induced nephropathy (CIN) in patients with baseline renal impairment undergoing cardiac catheterisation. Also, they concluded that the 12-hour sustained sodium chloride pre-hydration regimen was more protective than the 1-hour abbreviated sodium bicarbonate (SOB) regimen. Both N-acetylcysteine and SOB may have beneficial effects on CIN as prophylactic regimens. However, Chong et al. demonstrated the needless of combination of these two regimens. Because of some flaws in design of the study, I have some serious reservations about the findings of the present study.