[Prevention of contrast-induced nephropathy using cardiac catheterization combined with hydration, oral N-acetylcysteine, sodium bicarbonate and iso-osmolar contrast agents]

Abstract

Objectives: Contrast-induced nephropathy (CIN) after coronary angiography is a serious complication with an unfavorable prognosis. If CIN is persistent in the chronic phase, the prognosis is much worsened. We evaluated the efficacy of a new clinical therapy consisting of cardiac catheterization combined with hydration, oral N-acetylcysteine, sodium bicarbonate and iso-osmolar contrast agents.

Methods: The clinical therapy was applied to patients with pre-existent chronic renal insufficiency who underwent elective coronary angiography between December 2005 and December 2006. The incidence of CIN (defined as an increase > or = 25% and/or > or = 0.5 mg/dl in serum creatinine) persisting in the chronic phase at 30-60 days was examined in therapy era patients and compared with non-therapy era patients treated between January 2004 and November 2005, as well as patients with creatinine clearance < 40 ml/min.

Results: The clinical therapy was applied to 31 of 517 consecutive patients who underwent coronary angiography. CIN persisting in the chronic phase at 30-60 days occurred in 28 of 808 consecutive non-therapy era patients and 8 of 517 consecutive therapy era patients (3.5% vs 1.8%, p < 0.05). Excluding emergent cases, it occurred in 23 of 752 non-therapy era patients and 5 of 466 therapy era patients (3.1% vs 1.1%, p < 0.05). The patients with pre-existent chronic renal insufficiency (creatinine clearance < 40 ml/min) included 66 non-therapy era patients, and 21 of 31 therapy patients. Serum creatinine increased in the non-therapy era group (p < 0.01), but not in the therapy group. CIN persisting in the chronic phase at 30-60 days occurred in 21 non-therapy era group but in none of the therapy group.

Conclusions: Therapy for patients with renal failure consisting of cardiac catheterization combined with hydration, oral N-acetylcysteine, sodium bicarbonate and iso-osmolar contrast agents is effective to prevent CIN in the chronic phase.