Prevention of Contrast‐induced Nephropathy: A Single Center Randomized Study

Castini, Diego; Lucreziotti, Stefano; Bosotti, Laura; Uriarte, Diego Salerno; Sponzilli, Carlo; Verzoni, A; Lombardi, Federico

doi:10.1002/clc.20576

Cited by 23 publications

(15 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our results also show that oxidative injury plays an important role in FA-induced AKI, but that NAC is only effective for prevention not treatment. This study has thus confirmed and extended the observation that NAC is only effective in preventing AKI induced by nephrotoxic substances, but worsens AKI when given for treatment, at least under some conditions (19, 20, 21). While our results cannot be directly translated into clinical practice, they do raise important cautionary notes regarding the use of NAC in the clinical setting.…”

Section: Discussionsupporting

confidence: 82%

See 1 more Smart Citation

N-acetylcysteine is effective for prevention but not for treatment of folic acid-induced acute kidney injury in mice*

Wang

Peng

Wen

et al. 2011

Critical Care Medicine

View full text Add to dashboard Cite

Objectives There is controversy regarding the benefits of N-acetylcysteine (NAC) in acute kidney injury (AKI). This study was to compare three commonly used regimens and explore which regimen is best for the protection of AKI. Design Prospective experimental study. Setting University research laboratory. Interventions AKI was induced with folic acid (FA) intra-peritoneal injection in mice. Mice in pretreatment were treated with subcutaneous injection of NAC prior to the FA injection. Mice in posttreatment were treated with NAC after FA. Mice in pre +posttreatment were treated with NAC prior to FA and after FA. Placebo mice received vehicle only using the pre + posttreatment protocol. 14 healthy animals were given NAC to evaluate for toxicity and other 24 mice subjected to FA were sacrificed for kidney histology and analysis for oxidative injury. The same studies were also carried out in milder AKI (lower FA) model. Measurements and Main Results Plasma concentrations of creatinine, cystatin C and reduced glutathione (GSH) were measured. Survival time was assessed up to 7 days. The survival rates in NAC pretreatment mice were significantly better (73.33% vs. 46.67%, P<0.04) and AKI was significantly less compared to placebo. However, mice with posttreatment exhibited significantly worse survival and more severe AKI. Histological findings were consistent with functional parameters. GSH levels decreased less in NAC pretreatment but also increased beginning on day2 compared to placebo (11.5 vs 8.1 μg/ml, p<0.05). GSH levels did not increase in NAC posttreatment. However, three different NAC interventions neither significantly improved nor worsened renal function in the milder AKI model. Conclusion NAC pretreatment was effective in reducing the incidence and severity of AKI as well as in increasing survival. However, NAC posttreatment worsened FA toxicity. Only pretreatment was effective in increasing GSH. These data may help explain the variation from clinical studies of NAC use.

show abstract

Section: Discussionsupporting

confidence: 82%

“…Furthermore, the more severe the AKI is, the higher levels of the free iron are. It may explain why NAC was not effective in severe AKI in previous studies (16, 21). In severe sepsis, NAC treatment even aggravated organ failure (38).…”

Section: Discussionmentioning

confidence: 87%

N-acetylcysteine is effective for prevention but not for treatment of folic acid-induced acute kidney injury in mice*

Wang

Peng

Wen

et al. 2011

Critical Care Medicine

View full text Add to dashboard Cite

show abstract

“…Forty-eight eligible RCTs15–62 enrolled 14 709 patients with CKD undergoing CAG±PCI. Figure 1 shows the results of the search and the number of citations at different stages of the selection process.…”

Section: Resultsmentioning

confidence: 99%

Pharmacological interventions for the prevention of contrast-induced acute kidney injury in high-risk adult patients undergoing coronary angiography: a systematic review and meta-analysis of randomised controlled trials

et al. 2019

View full text Add to dashboard Cite

ObjectiveQuantify the efficacy of strategies to prevent contrast-induced acute kidney injury (CI-AKI) in high-risk patients undergoing coronary angiography (CAG) with or without percutaneous coronary intervention (PCI).BackgroundCI-AKI remains a common problem. The renoprotective efficacy of existing pharmacological agents remains uncertain in high-risk populations.MethodsSystematic review and meta-analysis of randomised controlled trials (RCTs) to compare different strategies versus hydration in patients with chronic kidney disease (CKD) undergoing CAG±PCI. Primary outcome was incident CI-AKI. Fixed-effects meta-analyses estimated ORs, 95% CIs and heterogeneity.ResultsForty-eight RCTs were included. Seven pharmacological strategies were evaluated by multiple RCTs and 10 by one RCT each. These had varying risk of bias; >25% of trials were at high risk of performance bias. Five strategies significantly reduced the odds of CI-AKI: N-acetylcysteine (NAC) (27 trials, 5694 participants; OR=0.77, 95% CI 0.65 to 0.91, p=0.002, I2=36%), ascorbic acid (four trials, 759 participants; OR=0.59, 95% CI 0.39 to 0.89, p=0.01, I2=0%), statin (two trials, 3234 participants; OR=0.59, 95% CI 0.39 to 0.89, p=0.75, I2=0%), trimetazidine (two trials, 214 participants; OR=0.27, 95% CI 0.10 to 0.71, p=0.01, I2=0%) and nicorandil (two trials, 389 participants; OR=0.47, 95% CI 0.23 to 0.94, p=0.03, I2=52%). Theophylline had a similar, but non-significant, effect. A subgroup analysis found that the benefit of NAC was highest in patients requiring a high-contrast dose.ConclusionsSeveral drugs are renoprotective in patients with CKD undergoing CAG±PCI. The evidence is strongest for NAC. We recommend that NAC should be used when a high dose of contrast is anticipated.Trial registration numberPROSPERO registration CRD42014014704.Open Science Framework link: https://osf.io/vxg7d/?view_only=62bad0404b18405abd39ff2ead2575a8

show abstract

“…Recent studies focused on the comparative effectiveness of IV sodium bicarbonate (bicarbonate) and IV sodium chloride (saline) based on the hypothesis that alkalinization of tubular fluid with bicarbonate will decrease the generation of injurious reactive oxygen species. Several trials suggested bicarbonate to be more effective than saline (5)(6)(7)(8)(9)(10)(11)(12), whereas others reported no difference (13)(14)(15)(16)(17)(18)(19)(20)(21). A second preventive intervention that has received substantial attention is the administration of N-acetylcysteine (NAC), an antioxidant with vasodilatory properties.…”

Section: Introductionmentioning

confidence: 99%

“…All used nominal changes in kidney function as the primary endpoint and most did not systematically track longer-term, patient-centered outcomes. Some used differing protocols for the administration of bicarbonate and saline, further complicating interpretation of the key results related to fluid composition (12,15,16,18,19).…”

Section: Introductionmentioning

confidence: 99%

Prevention of Contrast-Induced AKI

Weisbord¹,

Gallagher²,

Kaufman³

et al. 2013

Clinical Journal of the American Society of Nephrology

View full text Add to dashboard Cite

SummaryContrast-induced AKI (CI-AKI) is a common condition associated with serious, adverse outcomes. CI-AKI may be preventable because its risk factors are well characterized and the timing of renal insult is commonly known in advance. Intravenous (IV) fluids and N-acetylcysteine (NAC) are two of the most widely studied preventive measures for CI-AKI. Despite a multitude of clinical trials and meta-analyses, the most effective type of IV fluid (sodium bicarbonate versus sodium chloride) and the benefit of NAC remain unclear. Careful review of published trials of these interventions reveals design limitations that contributed to their inconclusive findings. Such design limitations include the enrollment of small numbers of patients, increasing the risk for type I and type II statistical errors; the use of surrogate primary endpoints defined by small increments in serum creatinine, which are associated with, but not necessarily causally related to serious, adverse, patient-centered outcomes; and the inclusion of low-risk patients with intact baseline kidney function, yielding low event rates and reduced generalizability to a higher-risk population. The Prevention of Serious Adverse Events following Angiography (PRESERVE) trial is a randomized, double-blind, multicenter trial that will enroll 8680 high-risk patients undergoing coronary or noncoronary angiography to compare the effectiveness of IV isotonic sodium bicarbonate versus IV isotonic sodium chloride and oral NAC versus oral placebo for the prevention of serious, adverse outcomes associated with CI-AKI. This article discusses key methodological issues of past trials investigating IV fluids and NAC and how they informed the design of the PRESERVE trial.

show abstract

Prevention of Contrast‐induced Nephropathy: A Single Center Randomized Study

Cited by 23 publications

References 24 publications

N-acetylcysteine is effective for prevention but not for treatment of folic acid-induced acute kidney injury in mice*

N-acetylcysteine is effective for prevention but not for treatment of folic acid-induced acute kidney injury in mice*

Pharmacological interventions for the prevention of contrast-induced acute kidney injury in high-risk adult patients undergoing coronary angiography: a systematic review and meta-analysis of randomised controlled trials

Prevention of Contrast-Induced AKI

Contact Info

Product

Resources

About