중탄산염 수액요법과 N-acetylcysteine의 조영제 신독성 예방효과

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.