Do Intravenous N-Acetylcysteine and Sodium Bicarbonate Prevent High Osmolal Contrast-Induced Acute Kidney Injury? A Randomized Controlled Trial
Autor(a) principal: | |
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Data de Publicação: | 2014 |
Outros Autores: | , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Institucional da UNIFESP |
Texto Completo: | http://repositorio.unifesp.br/handle/11600/38229 http://dx.doi.org/10.1371/journal.pone.0107602 |
Resumo: | Background: N-acetylcysteine (NAC) or sodium bicarbonate (NaHCO3), singly or combined, inconsistently prevent patients exposed to radiographic contrast media from developing contrast-induced acute kidney injury (CI-AKI).Objective: We asked whether intravenous isotonic saline and either NaHCO3 in 5% dextrose or else a high dose of NAC in 5% dextrose prevent CI-AKI in outpatients exposed to high-osmolal iodinated contrast medium more than does saline alone.Methods: This completed prospective, parallel, superiority, open-label, controlled, computer-randomized, single-center, Brazilian trial (NCT01612013) hydrated 500 adult outpatients (214 at high risk of developing CI-AKI) exposed to ioxitalamate during elective coronary angiography and ventriculography. From 1 hour before through 6 hours after exposure, 126 patients (group 1) received a high dose of NAC and saline, 125 (group 2) received NaHCO3 and saline, 124 (group 3) received both treatments, and 125 (group 4) received only saline.Results: Groups were similar with respect to age, gender, weight, pre-existing renal dysfunction, hypertension, medication, and baseline serum creatinine and serum cystatin C, but diabetes mellitus was significantly less prevalent in group 1. CI-AKI incidence 72 hours after exposure to contrast medium was 51.4% (257/500), measured as serum creatinine > (baseline+0.3 mg/dL) and/or serum cystatin C > (1.1 center dot baseline), and 7.6% (38/500), measured as both serum creatinine and serum cystatin C > (baseline+0.3 mg/dL) or > (1.25 center dot baseline). CI-AKI incidence measured less sensitively was similar among groups. Measured more sensitively, incidence in group 1 was significantly (p<0.05) lower than in groups 2 and 3 but not group 4; adjustment for confounding by infused volume equalized incidence in groups 1 and 3.Conclusion |
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Inda-Filho, Antonio JoseCaixeta, AdrianoManggini, MarciaSchor, Nestor [UNIFESP]Universidade de Brasília (UnB)Hosp Israelita Albert EinsteinUniversidade Federal de São Paulo (UNIFESP)2016-01-24T14:37:53Z2016-01-24T14:37:53Z2014-09-25Plos One. San Francisco: Public Library Science, v. 9, n. 9, 9 p., 2014.1932-6203http://repositorio.unifesp.br/handle/11600/38229http://dx.doi.org/10.1371/journal.pone.0107602WOS000344862300025.pdf10.1371/journal.pone.0107602WOS:000344862300025Background: N-acetylcysteine (NAC) or sodium bicarbonate (NaHCO3), singly or combined, inconsistently prevent patients exposed to radiographic contrast media from developing contrast-induced acute kidney injury (CI-AKI).Objective: We asked whether intravenous isotonic saline and either NaHCO3 in 5% dextrose or else a high dose of NAC in 5% dextrose prevent CI-AKI in outpatients exposed to high-osmolal iodinated contrast medium more than does saline alone.Methods: This completed prospective, parallel, superiority, open-label, controlled, computer-randomized, single-center, Brazilian trial (NCT01612013) hydrated 500 adult outpatients (214 at high risk of developing CI-AKI) exposed to ioxitalamate during elective coronary angiography and ventriculography. From 1 hour before through 6 hours after exposure, 126 patients (group 1) received a high dose of NAC and saline, 125 (group 2) received NaHCO3 and saline, 124 (group 3) received both treatments, and 125 (group 4) received only saline.Results: Groups were similar with respect to age, gender, weight, pre-existing renal dysfunction, hypertension, medication, and baseline serum creatinine and serum cystatin C, but diabetes mellitus was significantly less prevalent in group 1. CI-AKI incidence 72 hours after exposure to contrast medium was 51.4% (257/500), measured as serum creatinine > (baseline+0.3 mg/dL) and/or serum cystatin C > (1.1 center dot baseline), and 7.6% (38/500), measured as both serum creatinine and serum cystatin C > (baseline+0.3 mg/dL) or > (1.25 center dot baseline). CI-AKI incidence measured less sensitively was similar among groups. Measured more sensitively, incidence in group 1 was significantly (p<0.05) lower than in groups 2 and 3 but not group 4; adjustment for confounding by infused volume equalized incidence in groups 1 and 3.ConclusionHospital das Forc, as Armadas e Instituto de Cardiologia de BrasiliaUniv Brasilia, Div Nefrol, Hosp Univ Brasilia, Brasilia, DF, BrazilHosp Israelita Albert Einstein, São Paulo, BrazilUniv Brasilia, Hosp Univ Brasilia, Brasilia, DF, BrazilUniversidade Federal de São Paulo, São Paulo, BrazilUniversidade Federal de São Paulo, EPM, São Paulo, BrazilWeb of Science9engPublic Library SciencePlos OneDo Intravenous N-Acetylcysteine and Sodium Bicarbonate Prevent High Osmolal Contrast-Induced Acute Kidney Injury? A Randomized Controlled Trialinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleinfo:eu-repo/semantics/openAccessreponame:Repositório Institucional da UNIFESPinstname:Universidade Federal de São Paulo (UNIFESP)instacron:UNIFESPORIGINALWOS000344862300025.pdfapplication/pdf645273${dspace.ui.url}/bitstream/11600/38229/1/WOS000344862300025.pdf74fea8b0c41e2ef3b0a84ffe44eb07c7MD51open accessTEXTWOS000344862300025.pdf.txtWOS000344862300025.pdf.txtExtracted texttext/plain47460${dspace.ui.url}/bitstream/11600/38229/2/WOS000344862300025.pdf.txt53c5d01ab8261908af04116df1fbd3a4MD52open access11600/382292022-06-02 09:13:01.054open accessoai:repositorio.unifesp.br:11600/38229Repositório InstitucionalPUBhttp://www.repositorio.unifesp.br/oai/requestopendoar:34652022-06-02T12:13:01Repositório Institucional da UNIFESP - Universidade Federal de São Paulo (UNIFESP)false |
dc.title.en.fl_str_mv |
Do Intravenous N-Acetylcysteine and Sodium Bicarbonate Prevent High Osmolal Contrast-Induced Acute Kidney Injury? A Randomized Controlled Trial |
title |
Do Intravenous N-Acetylcysteine and Sodium Bicarbonate Prevent High Osmolal Contrast-Induced Acute Kidney Injury? A Randomized Controlled Trial |
spellingShingle |
Do Intravenous N-Acetylcysteine and Sodium Bicarbonate Prevent High Osmolal Contrast-Induced Acute Kidney Injury? A Randomized Controlled Trial Inda-Filho, Antonio Jose |
title_short |
Do Intravenous N-Acetylcysteine and Sodium Bicarbonate Prevent High Osmolal Contrast-Induced Acute Kidney Injury? A Randomized Controlled Trial |
title_full |
Do Intravenous N-Acetylcysteine and Sodium Bicarbonate Prevent High Osmolal Contrast-Induced Acute Kidney Injury? A Randomized Controlled Trial |
title_fullStr |
Do Intravenous N-Acetylcysteine and Sodium Bicarbonate Prevent High Osmolal Contrast-Induced Acute Kidney Injury? A Randomized Controlled Trial |
title_full_unstemmed |
Do Intravenous N-Acetylcysteine and Sodium Bicarbonate Prevent High Osmolal Contrast-Induced Acute Kidney Injury? A Randomized Controlled Trial |
title_sort |
Do Intravenous N-Acetylcysteine and Sodium Bicarbonate Prevent High Osmolal Contrast-Induced Acute Kidney Injury? A Randomized Controlled Trial |
author |
Inda-Filho, Antonio Jose |
author_facet |
Inda-Filho, Antonio Jose Caixeta, Adriano Manggini, Marcia Schor, Nestor [UNIFESP] |
author_role |
author |
author2 |
Caixeta, Adriano Manggini, Marcia Schor, Nestor [UNIFESP] |
author2_role |
author author author |
dc.contributor.institution.none.fl_str_mv |
Universidade de Brasília (UnB) Hosp Israelita Albert Einstein Universidade Federal de São Paulo (UNIFESP) |
dc.contributor.author.fl_str_mv |
Inda-Filho, Antonio Jose Caixeta, Adriano Manggini, Marcia Schor, Nestor [UNIFESP] |
description |
Background: N-acetylcysteine (NAC) or sodium bicarbonate (NaHCO3), singly or combined, inconsistently prevent patients exposed to radiographic contrast media from developing contrast-induced acute kidney injury (CI-AKI).Objective: We asked whether intravenous isotonic saline and either NaHCO3 in 5% dextrose or else a high dose of NAC in 5% dextrose prevent CI-AKI in outpatients exposed to high-osmolal iodinated contrast medium more than does saline alone.Methods: This completed prospective, parallel, superiority, open-label, controlled, computer-randomized, single-center, Brazilian trial (NCT01612013) hydrated 500 adult outpatients (214 at high risk of developing CI-AKI) exposed to ioxitalamate during elective coronary angiography and ventriculography. From 1 hour before through 6 hours after exposure, 126 patients (group 1) received a high dose of NAC and saline, 125 (group 2) received NaHCO3 and saline, 124 (group 3) received both treatments, and 125 (group 4) received only saline.Results: Groups were similar with respect to age, gender, weight, pre-existing renal dysfunction, hypertension, medication, and baseline serum creatinine and serum cystatin C, but diabetes mellitus was significantly less prevalent in group 1. CI-AKI incidence 72 hours after exposure to contrast medium was 51.4% (257/500), measured as serum creatinine > (baseline+0.3 mg/dL) and/or serum cystatin C > (1.1 center dot baseline), and 7.6% (38/500), measured as both serum creatinine and serum cystatin C > (baseline+0.3 mg/dL) or > (1.25 center dot baseline). CI-AKI incidence measured less sensitively was similar among groups. Measured more sensitively, incidence in group 1 was significantly (p<0.05) lower than in groups 2 and 3 but not group 4; adjustment for confounding by infused volume equalized incidence in groups 1 and 3.Conclusion |
publishDate |
2014 |
dc.date.issued.fl_str_mv |
2014-09-25 |
dc.date.accessioned.fl_str_mv |
2016-01-24T14:37:53Z |
dc.date.available.fl_str_mv |
2016-01-24T14:37:53Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
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info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.citation.fl_str_mv |
Plos One. San Francisco: Public Library Science, v. 9, n. 9, 9 p., 2014. |
dc.identifier.uri.fl_str_mv |
http://repositorio.unifesp.br/handle/11600/38229 http://dx.doi.org/10.1371/journal.pone.0107602 |
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1932-6203 |
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WOS000344862300025.pdf |
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10.1371/journal.pone.0107602 |
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Plos One. San Francisco: Public Library Science, v. 9, n. 9, 9 p., 2014. 1932-6203 WOS000344862300025.pdf 10.1371/journal.pone.0107602 WOS:000344862300025 |
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http://repositorio.unifesp.br/handle/11600/38229 http://dx.doi.org/10.1371/journal.pone.0107602 |
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