1. Preventive Strategies of Renal Insufficiency in Patients With Diabetes Undergoing Intervention or Arteriography (the PREVENT Trial)
- Author
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Sang-Yong Yoo, Won-Jang Kim, Jon Suh, Seong-Wook Park, Soo-Jin Kang, Nae-Hee Lee, Bong Ki Lee, Young-Hak Kim, Jae-Hwan Lee, Sang-Sig Cheong, Jong-Young Lee, Se-Whan Lee, Cheol Whan Lee, Sung-Cheol Yun, Si Wan Choi, Jae-Sik Jang, Duk-Woo Park, Won-Yong Shin, Seung-Jung Park, Yoon Haeng Cho, In Whan Seong, Min-Su Hyon, Sang-Gon Lee, and Seung-Whan Lee
- Subjects
Male ,medicine.medical_specialty ,medicine.medical_treatment ,Urology ,Administration, Oral ,Contrast Media ,Renal function ,Sodium Chloride ,Coronary Angiography ,Nephropathy ,Diabetic nephropathy ,chemistry.chemical_compound ,Internal medicine ,medicine ,Humans ,Diabetic Nephropathies ,Renal Insufficiency ,Myocardial infarction ,Angioplasty, Balloon, Coronary ,Aged ,Creatinine ,Sodium bicarbonate ,business.industry ,Middle Aged ,medicine.disease ,Acetylcysteine ,Surgery ,Sodium Bicarbonate ,chemistry ,Cardiology ,Female ,Hemodialysis ,Cardiology and Cardiovascular Medicine ,business ,Kidney disease - Abstract
Few studies have compared the ability of sodium bicarbonate plus N-acetylcysteine (NAC) and sodium chloride plus NAC to prevent contrast-induced nephropathy (CIN) in diabetic patients with impaired renal function undergoing coronary or endovascular angiography or intervention. Diabetic patients (n = 382) with renal disease (serum creatinine ≥1.1 mg/dl and estimated glomerular filtration rate60 ml/min/1.73 m(2)) were randomly assigned to receive prophylactic sodium chloride (saline group, n = 189) or sodium bicarbonate (bicarbonate group, n = 193) before elective coronary or endovascular angiography or intervention. All patients received oral NAC 1,200 mg 2 times/day for 2 days. The primary end point was CIN, defined as an increase in serum creatinine25% or an absolute increase in serum creatinine ≥0.5 mg/dl within 48 hours after contrast exposure. There were no significant between-group differences in baseline characteristics. The primary end point was met in 10 patients (5.3%) in the saline group and 17 (9.0%) in the bicarbonate group (p = 0.17), with 2 (1.1%) and 4 (2.1%), respectively, requiring hemodialysis (p = 0.69). Rates of death, myocardial infarction, and stroke did not differ significantly at 1 month and 6 months after contrast exposure. In conclusion, hydration with sodium bicarbonate is not superior to hydration with sodium chloride in preventing CIN in patients with diabetic nephropathy undergoing coronary or endovascular angiography or intervention.
- Published
- 2011