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Prevention of Contrast-Induced Nephropathy in Patients Undergoing Emergent Coronary Procedures

      In a recent report by Masuda et al,
      • Masuda M.
      • Yamada T.
      • Mine T.
      • Morita T.
      • Tamaki S.
      • Tsukamoto Y.
      • Okuda K.
      • Iwasaki Y.
      • Hori M.
      • Fukunami M.
      Comparison of usefulness of sodium bicarbonate versus sodium chloride to prevent contrast-induced nephropathy in patients undergoing an emergent coronary procedure.
      the investigators found that the infusion of sodium bicarbonate, compared with sodium chloride, had a protective effect on the incidence of contrast-induced nephropathy (CIN) in patients who underwent emergent coronary procedures. As the investigators stated, the risk for CIN after an emergency coronary procedure is particularly high and is strongly associated with poor clinical outcomes.
      • Bouzas-Mosquera A.
      • Vázquez-Rodríguez J.M.
      • Calviño-Santos R.
      • Peteiro-Vázquez J.
      • Flores-Ríos X.
      • Marzoa-Rivas R.
      • Pinon-Esteban P.
      • Aldama-Lopez G.
      • Salgado-Fernandez J.
      • Vazquez-Gonzalez N.
      • Castro-Beiras A.
      Contrast-induced nephropathy and acute renal failure following emergent cardiac catheterization: incidence, risk factors and prognosis.
      Nevertheless, few studies have evaluated the efficacy of preventive measures on the incidence of CIN after an emergency coronary procedure. Marenzi et al
      • Marenzi G.
      • Assanelli E.
      • Marana I.
      • Lauri G.
      • Campodonico J.
      • Grazi M.
      • De Metrio M.
      • Galli S.
      • Fabbiocchi F.
      • Montorsi P.
      • et al.
      N-acetylcysteine and contrast-induced nephropathy in primary angioplasty.
      found that N-acetylcysteine (NAC) prevented CIN development compared with placebo in patients with acute myocardial infarctions who underwent primary angioplasty. Masuda et al
      • Masuda M.
      • Yamada T.
      • Mine T.
      • Morita T.
      • Tamaki S.
      • Tsukamoto Y.
      • Okuda K.
      • Iwasaki Y.
      • Hori M.
      • Fukunami M.
      Comparison of usefulness of sodium bicarbonate versus sodium chloride to prevent contrast-induced nephropathy in patients undergoing an emergent coronary procedure.
      indicated that studies are needed to examine the efficacy of combination therapy with sodium bicarbonate plus intravenous NAC on the prevention of CIN after an emergency coronary procedure. A recent study addressed this issue: in a randomized, single-center trial, Recio-Mayoral et al
      • Recio-Mayoral A.
      • Chaparro M.
      • Prado B.
      • Cozar R.
      • Mendez I.
      • Banerjee D.
      • Kaski J.C.
      • Cubero J.
      • Cruz J.M.
      The reno-protective effect of hydration with sodium bicarbonate plus N-acetylcysteine in patients undergoing emergency percutaneous coronary intervention: the RENO study.
      compared the effect of an infusion of sodium bicarbonate plus NAC versus isotonic saline in 111 patients who underwent emergency percutaneous coronary interventions; the incidence of CIN (defined as an increase in serum creatinine of ≥0.5 mg/dl <72 hours after the procedure) was significantly lower in the group receiving sodium bicarbonate plus NAC (1.8% vs 21.8%, p <0.001); these results agree with those reported in the Renal Insufficiency Following Contrast Media Administration Trial (REMEDIAL),
      • Briguori C.
      • Airoldi F.
      • D’Andrea D.
      • Bonizzoni E.
      • Morici N.
      • Focaccio A.
      • Michev I.
      • Montorfano M.
      • Carlino M.
      • Cosgrave J.
      • et al.
      Renal Insufficiency Following Contrast Media Administration Trial (REMEDIAL): a randomized comparison of 3 preventive strategies.
      which suggested an additive protective effect of sodium bicarbonate plus NAC on the incidence of CIN in patients with chronic renal failure who underwent elective coronary or peripheral procedures.
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      References

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