Document Detail


Use of NaCl saline hydration and N-Acetyl Cysteine to prevent contrast induced nephropathy in different populations of patients at high and low risk undergoing coronary artery angiography.
MedLine Citation:
PMID:  20145594     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
AIM: Contrast-induced nephropathy (CIN) is most commonly defined as acute renal failure occurring within 48-72 h of exposure to intravascular radiographic contrast medium that is not attributable to other causes. In international literature a 25% increase in serum creatinine levels or an increase in absolute values of 0.5 mg/dL from baseline has been suggested to define CIN. The reported incidence of CIN varies widely, ranging from 2% to 50%. This variability results from differences in the presence or absence of risk factors. With a retrospective analysis authors evaluated the use of NaCl saline hydration and N-acetyl cysteine (NAC) to prevent CIN in different populations of patients at high and low risk undergoing coronary artery angiography. METHODS: From January 2007 to December 2008, 597 patients underwent coronary artery angiography with a low osmolarity contrast agent. Nephrotoxic drugs such as diuretics, metformin, ACE-I and ARBs were stopped at least 24 h before the procedure. The population was divided into two groups: group A (high risk 342 patients, 57.2%) identified for the presence of at least one risk factor such as diabetes, age >65 years, baseline creatinine >1.4 mg/dL and group B (low risk 255 patients, 42.8%) for the absence of any of the risk mentioned above. Only group A was treated with a saline hydration (1 mL/kg/h) plus NAC 600 mg 12 h before and 12 h after the procedure. RESULTS: The overall incidence of CIN was 6.7% (40 patients). In particular, the incidence of CIN was 4.4% (15 patients) in the group A and 9.8% (25 patients) in the group B respectively (P=0.017). Interestingly, the Contrast Index (volume administrated/theoretical maximum volume) was significantly lower in group B (P<0.005). In the multivariate analysis, including risk factors such as age, diabetes, hypertension, hypercholesterol-mia, current smoke, baseline creatinine level, Contrast Index and hydration, the last variable was the only one inversely correlated independently with the incidence of CIN (P=0.001). CONCLUSIONS: The hydration with saline and NAC is an effective and low-cost tool in preventing CIN in patients undergoing coronary artery angiography and, according to the current guidelines, should be used in all high-risk patients. Present results show that even in patients at low risk for CIN, hydration could be useful: in fact, despite the Contrast Index was significantly lower in this population, the incidence of CIN was greater, thus suggesting a potential role for hydration also in the low-risk population.
Authors:
P Calabrò; R Bianchi; M Caprile; C Sordelli; M Cappelli Bigazzi; R Palmieri; G Gigantino; G Limongelli; G Capozzi; S Cuomo; R Calabrò
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Minerva cardioangiologica     Volume:  58     ISSN:  0026-4725     ISO Abbreviation:  Minerva Cardioangiol     Publication Date:  2010 Feb 
Date Detail:
Created Date:  2010-02-10     Completed Date:  2010-09-02     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0400725     Medline TA:  Minerva Cardioangiol     Country:  Italy    
Other Details:
Languages:  eng     Pagination:  35-40     Citation Subset:  IM    
Affiliation:
Department of Cardiothoracic Sciences, Second University of Naples, Monaldi Hospital, Naples, Italy. paolo.calabro@unina2.it
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MeSH Terms
Descriptor/Qualifier:
Acetylcysteine / therapeutic use*
Aged
Contrast Media / adverse effects*
Coronary Angiography*
Female
Humans
Kidney Diseases / chemically induced*,  prevention & control*
Male
Middle Aged
Retrospective Studies
Risk Factors
Sodium Chloride / therapeutic use*
Chemical
Reg. No./Substance:
0/Contrast Media; 616-91-1/Acetylcysteine; 7647-14-5/Sodium Chloride

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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