| 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. | |
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MedLine Citation:
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PMID: 19490358 Owner: NLM Status: In-Process |
Abstract/OtherAbstract:
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We reviewed data from the multicenter CARE (Cardiac Angiography in Renally Impaired Patients) study to see if benefit could be shown for N-acetylcysteine (NAC) in patients undergoing cardiac angiography who all received intravenous bicarbonate fluid expansion. Four hundred fourteen patients with moderate-to-severe chronic kidney disease were randomized to receive intra-arterial administration of iopamidol-370 or iodixanol-320. All patients were prehydrated with isotonic sodium bicarbonate solution. Each site chose whether or not to administer NAC 1,200 mg twice daily to all patients. Serum creatinine (SCr) levels and estimated glomerular filtration rate were assessed at baseline and 2-5 days after receiving contrast. The primary outcome was a postdose SCr increase 0.5 mg/dL (44.2 mumol/L) over baseline. Secondary outcomes were a postdose SCr increase 25% and the mean peak change in SCr. The NAC group received significantly less hydration (892 +/- 236 mL vs. 1016 +/- 328 mL; P < 0.001) and more contrast volume (146 +/- 74 mL vs. 127 +/- 71 mL; P = 0.009) compared with no-NAC group. SCr increases 0.5 mg/dL occurred in 4.2% (7 of 168 patients) in NAC group and 6.5% (16 of 246 patients) in no-NAC group (P = 0.38); rates of SCr increases 25% were 11.9% and 10.6%, respectively (P = 0.75); mean post-SCr increases were 0.07 mg/dL in NAC group versus 0.11 mg/dL in no-NAC group (P = 0.14). In conclusion, addition of NAC to fluid expansion with sodium bicarbonate failed to reduce the rate of contrast-induced nephropathy (CIN) after the intra-arterial administration of iopamidol or iodixanol to high-risk patients with chronic kidney disease. |
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Authors:
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Cezar S Staniloae; Serge Doucet; Samin K Sharma; Richard E Katholi; Kanika R Mody; John T Coppola; Richard Solomon |
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Publication Detail:
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Type: Comparative Study; Journal Article; Multicenter Study Date: 2009-03-13 |
Journal Detail:
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Title: Journal of interventional cardiology Volume: 22 ISSN: 1540-8183 ISO Abbreviation: J Interv Cardiol Publication Date: 2009 Jun |
Date Detail:
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Created Date: 2009-07-29 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8907826 Medline TA: J Interv Cardiol Country: United States |
Other Details:
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Languages: eng Pagination: 261-5 Citation Subset: IM |
Affiliation:
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St. Vincent's Hospital Manhattan, New York, New York 10011, USA. cstaniloae@svcmcny.org |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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