How Strong Is the Evidence for Sodium Bicarbonate to Prevent Contrast-Induced Acute Kidney Injury After Coronary Angiography and Percutaneous Coronary Intervention?

Dong, Yang; Zhang, Bin; Liang, Long; Zhou, Lian; Liu, Jing; Liang, Changhong; Zhang, Shuixing

doi:10.1097/md.0000000000002715

Cited by 10 publications

(4 citation statements)

References 43 publications

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“…As mentioned earlier, there are numerous efforts to limit the damaging effects of coronary intervention and specifically the contrast agents on the kidneys [ 4 – 6 ]. Several of such approaches have failed, proved to be non-practical, or gave mixed results at best [ 20 , 21 ]. Spironolactone is poorly studied in this regard given its proven benefit in animal studies [ 7 – 9 ]; two studies in cardiac surgery units reported its effect on ischemic kidney injury.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Spironolactone on the Incidence of Contrast-Induced Nephropathy in Patients Undergoing Cardiac Catheterization: Study Design and Rationale

et al. 2018

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IntroductionPatients undergoing coronary catheterization are at high risk of developing contrast-induced nephropathy (CIN) acute kidney injury (AKI). Several approaches have been supposed to limit such an effect but with mixed results or non-practical methods. Spironolactone is supposed to be effective as a nephroprotective agent in animal studies. This study will try to measure the effect of spironolactone on the incidence of CIN-AKI in patients undergoing coronary catheterization (angiography angioplasty).MethodsThis study is a single-center, investigator-driven, double-blinded randomized controlled study in Iraq-Basra. More than 400 patients admitted for coronary angio unit in our center will be allocated in a 1:1 ratio to receive either spironolactone 200 mg single dose or placebo in addition to their usual premedication.Planned OutcomesPrimary end point will be CIN defined as more than 25% or 0.3 mg/dl elevation in serum creatinine (S.Cr.) from baseline during the first 2–3 days after the procedure. We hope to identify or answer an important question regarding CIN in such high-risk patients.Trial RegistrationClinicalTrials.gov Identifier, NCT03329443.

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Section: Discussionmentioning

confidence: 99%

The Effect of Spironolactone on the Incidence of Contrast-Induced Nephropathy in Patients Undergoing Cardiac Catheterization: Study Design and Rationale

et al. 2018

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“…To date, intravenous loading with a 0.9% NaCl solution is the only proved efficient CIAKI prophylactic measure [9,41,42,45,[73][74][75][76]. Despite the aforesaid superiority of using intravenous sodium bicarbonate, its role in nephropathy prophylaxis is comparable to 0.9% NaCl, based on the findings of some randomized studies [66,73,75,77]. Although one study did show the benefits of high sodium bicarbonate concentrations (833 mEq/L) [78], clinical guidelines for nephropathy prophylaxis have not supported this fact.…”

Section: Prophylaxismentioning

confidence: 99%

Contrast-induced Acute Kidney Injury: A Contemporary Review

Khilchuk¹,

Власенко²,

Scherbak³

et al. 2018

Int J Ren Dis Ther

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Clinically significant Contrast-Induced Acute Kidney Injury (CIAKI) is a severe complication of interventional contrast-based procedures of all kinds. It involves high morbidity, mortality, social and financial losses. Acute renal damage after coronary angiography or percutaneous coronary intervention may occur in 1-2% of cases in the general population or 50+% of cases with high CIAKI exposure. It is essential to detect high-risk patients with renal damage as a major and frequent CIAKI predisposing factor. There are novel biomarkers with rapid or nearly instant response to acute subclinical contrast-induced renal damage, which are highly valuable in CIAKI diagnosis and for this reason desire deeper clinical research. Despite a number of controversies, prophylactic and therapeutic measures are practically the same in a vast majority of guidelines. An intravenous 0.9% NaCl solution remains the only proven measure in CIAKI prophylaxis and treatment, while the use of other pharmacological approaches still needs more relevant prospective clinical research. The aim of this paper was to review contemporary evidencebased CIAKI data.

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“…Contrast-induced acute kidney injury (CI-AKI) is one of the common complications of coronary diagnostic and interventional procedures, which is significantly associated with prolonged hospitalization, health cost and increased mortality [ 1 , 2 ]. Although the definition of CI-AKI varies, it is usually defined as an increase in the serum creatinine (Scr) level of 25% or an increase of 0.5 mg/dL (or 44 μmol/L) from baseline within 48-72 h of contrast exposure [ 3 , 4 ]. Identifying patients at risk of CI-AKI easily and accurately would allow the administration of prophylactic interventions to those at high risk [ 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

Development of a preprocedure nomogram for predicting contrast-induced acute kidney injury after coronary angiography or percutaneous coronary intervention

et al. 2017

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Most of the risk models for predicting contrast-induced acute kidney injury (CI-AKI) are available for postcontrast exposure prediction, thus have limited values in practice. We aimed to develop a novel nomogram based on preprocedural features for early prediction of CI-AKI in patients after coronary angiography (CAG) or percutaneous coronary intervention (PCI). A total of 245 patients were retrospectively reviewed from January 2015 to January 2017. Least absolute shrinkage and selection operator (Lasso) regression model was applied to select most strong predictors for CI-AKI. The CI-AKI risk score was calculated for each patient as a linear combination of selected predictors that were weighted by their respective coefficients. The discrimination of nomogram was assessed by C-statistic. The occurrence of CI-AKI was 13.9% (34 out of 245). We identified ten predictors including sex, diabetes mellitus, lactate dehydrogenase level, C-reactive protein, years since drinking, chronic kidney disease (CKD), stage of CKD, stroke, acute myocardial infarction, and systolic blood pressure. The CI-AKI prediction nomogram obtained good discrimination (C-statistic, 0.718, 95%CI: 0.637-0.800, p = 7.23 × 10-5). The cutoff value of CI-AKI risk score was -1.953. Accordingly, the novel nomogram we developed is a simple and accurate tool for preprocedural prediction of CI-AKI in patients undergoing CAG or PCI.

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How Strong Is the Evidence for Sodium Bicarbonate to Prevent Contrast-Induced Acute Kidney Injury After Coronary Angiography and Percutaneous Coronary Intervention?

Abstract: Supplemental Digital Content is available in the text

Cited by 10 publications

References 43 publications

The Effect of Spironolactone on the Incidence of Contrast-Induced Nephropathy in Patients Undergoing Cardiac Catheterization: Study Design and Rationale

The Effect of Spironolactone on the Incidence of Contrast-Induced Nephropathy in Patients Undergoing Cardiac Catheterization: Study Design and Rationale

Contrast-induced Acute Kidney Injury: A Contemporary Review

Development of a preprocedure nomogram for predicting contrast-induced acute kidney injury after coronary angiography or percutaneous coronary intervention

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