Sodium Bicarbonate-Ascorbic Acid Combination for Prevention of Contrast-Induced Nephropathy in Chronic Kidney Disease Patients Undergoing Catheterization

Abstract

ography and intervention. 11 Similarly, although Spargias et al reported that ascorbic acid protected against CIN in high-risk patients undergoing a coronary procedure, 12 the REMEDIAL trial could not prove the superiority of ascorbic acid. 13 No published studies have examined the efficacy of combined i.v. sodium bicarbonate and ascorbic acid for the prevention of CIN. The aim of the current prospective randomized trial was therefore to determine whether i.v. sodium bicarbonate and ascorbic acid, in addition to a saline hydration protocol, provided more effective prevention of CIN than saline hydration alone in CKD patients undergoing elective catheter procedures. A cute renal dysfunction is a serious complication of contrast agent use. 1 This contrast-induced nephropathy (CIN) occurs more commonly in patients with pre-existing renal dysfunction. 2-4 Once CIN occurs, patients are more likely to experience in-hospital death and have a markedly less favorable long-term prognosis. 2,4-6 The incidence of CIN is <2% in patients with normal renal function, 7 but 11-45% in patients with diabetes or chronic kidney disease (CKD). 8,9 Given that non-nephrotoxic contrast agents are currently unavailable, prevention of the onset of CIN is extremely important, especially for CKD. In a study of CKD patients who underwent an elective coronary procedure, Tamura et al noted that a single i.v. bolus of sodium bicarbonate (20 mEq), in addition to standard hydration, prevented CIN more effectively than standard hydration alone. 10 The PREVENT trial, however, suggested that hydration with sodium bicarbonate was not superior to hydration with sodium chloride in preventing CIN in patients undergoing coronary or endovascular angi- Methods Patients

Chronic Intermittent Hypobaric Hypoxia Prevents contrast-Induced Acute Kidney Injury by Modulating the HIF-1α Signaling Pathway

“…In the general population, the incidence of CI-AKI is 2.0%, but in the population with comorbid chronic kidney disease, diabetes, advanced age, and emergency percutaneous coronary intervention (PCI), the incidence of CI-AKI rises to 30% [24]. Although studies have shown that some drugs or methods have a preventive effect on CI-AKI, such as lignans [25], acetylcysteine[26], sodium bicarbonate [27], hydration[28]etc. But, there is still no consensus on these methods.…”

Chronic Intermittent Hypobaric Hypoxia Prevents Contrast-Induced Acute Kidney Injury By Modulating The HIF-1α Signaling Pathway

“…In the general population, the incidence of CI-AKI is 2.0%, but in the population with comorbid chronic kidney disease, diabetes, advanced age, and emergency percutaneous coronary intervention (PCI), the incidence of CI-AKI rises to 30% [24]. Although studies have shown that some drugs or methods have a preventive effect on CI-AKI, such as lignans [25], acetylcysteine [26], sodium bicarbonate [27], hydration [28]etc. But, there is still no consensus on these methods.…”

Guideline on the use of iodinated contrast media in patients with kidney disease 2018

“…Ascorbic acid exerts an antioxidant action against ROS and potentiates the effects of other antioxidants. Ten RCTs on ascorbic acid for CIN prevention have been conducted, among which 6 RCTs were published after 2011 [241,252,257,[270][271][272][273][274][275][276]. All of the studies targeted patients undergoing cardiovascular interventions, and no study targeted patients who received intravenous contrast media.…”