중탄산염 수액요법과 N-acetylcysteine의 조영제 신독성 예방효과Intravenous Sodium Bicarbonate and Oral N-acetylcysteine for the Prevention of Contrast-Induced Nephropathy
- Other Titles
- Intravenous Sodium Bicarbonate and Oral N-acetylcysteine for the Prevention of Contrast-Induced Nephropathy
- Authors
- 구태연; 김지현; 이제; 신진호; 김경수; 최보율; 박준성; 이창화; 강종명; 김근호
- Issue Date
- May-2011
- Publisher
- 대한내과학회
- Keywords
- 조영제; 급성신부전; 식염수; 중탄산염; 아세틸시스테인; Contrast media; Acute kidney failure; Sodium chloride; Sodium bicarbonate; Acetylcysteine
- Citation
- 대한내과학회지, v.80, no.5, pp.537 - 545
- Indexed
- KCI
- Journal Title
- 대한내과학회지
- Volume
- 80
- Number
- 5
- Start Page
- 537
- End Page
- 545
- URI
- https://scholarworks.bwise.kr/hanyang/handle/2021.sw.hanyang/168471
- ISSN
- 1738-9364
- Abstract
- Background/Aims:The value of hydration with sodium bicarbonate and N-acetylcysteine (NAC) in the prevention of radiocontrast-induced nephropathy is questionable. This study investigated whether sodium bicarbonate hydration with or without NAC has a more protective role in the prevention of radiocontrast-induced nephropathy than saline hydration with or without NAC.
Methods: We prospectively studied 100 patients with significant proteinuria (≥ 500 mg/d), azotemia (serum creatinine ≥ 1.5 mg/dL), or diabetes mellitus who were undergoing coronary angiography using iodixanol, a nonionic iso-osmolar contrast agent. Patients were assigned randomly to receive saline infusion (S, n = 24), saline infusion plus NAC (S + NAC, n = 20), sodium bicarbonate infusion (B, n = 25), and sodium bicarbonate plus NAC (B + NAC, n = 31). Contrast-induced nephropathy was defined as an increase of 25% or more in the serum creatinine within 48 hours of contrast exposure.
Results: There were no significant group differences in age, sex, and basal serum creatinine. Contrast-induced nephropathy occurred in 20 patients (20%) and its incidence was not significantly different among the groups; four from group S, five from group S + NAC, five from group B, and six from group B + NAC. The incidences were not significantly different when compared between S and B, irrespective of the use of NAC (21 vs. 20%), and when compared according to the presence of pre-existing azotemia (19 vs. 20%).
Conclusions:The efficacy of sodium bicarbonate hydration in the prevention of contrast-induced nephropathy seems comparable to that of saline hydration, and it was not improved by the addition of NAC.
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