| [PMID]: | 29420536 |
| [Au] Autor: | Kooiman J; de Vries JPM; Van der Heyden J; Sijpkens YWJ; van Dijkman PRM; Wever JJ; van Overhagen H; Vahl AC; Aarts N; Verberk-Jonkers IJAM; Brulez HFH; Hamming JF; van der Molen AJ; Cannegieter SC; Putter H; van den Hout WB; Kilicsoy I; Rabelink TJ; Huisman MV |
| [Ad] Endereço: | Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands. |
| [Ti] Título: | Randomized trial of one-hour sodium bicarbonate vs standard periprocedural saline hydration in chronic kidney disease patients undergoing cardiovascular contrast procedures. |
| [So] Source: | PLoS One;13(2):e0189372, 2018. |
| [Is] ISSN: | 1932-6203 |
| [Cp] País de publicação: | United States |
| [La] Idioma: | eng |
| [Ab] Resumo: | BACKGROUND: Guidelines advise periprocedural saline hydration for prevention of contrast induced-acute kidney injury (CI-AKI). We analysed whether 1-hour sodium bicarbonate hydration administered solely prior to intra-arterial contrast exposure is non-inferior to standard periprocedural saline hydration in chronic kidney disease (CKD) patients undergoing elective cardiovascular diagnostic or interventional contrast procedures. METHODS: We performed an open-label multicentre non-inferiority trial between 2011-2014. Patients were randomized to 1 hour pre-procedure sodium bicarbonate hydration (250 ml 1.4%, N = 168) or 4-12 hours saline hydration (1000 ml 0.9%, N = 165) prior to and following contrast administration (2000 ml of saline total). Primary outcome was the relative serum creatinine increase (%) 48-96 hours post contrast exposure. Secondary outcomes were: incidence of CI-AKI (serum creatinine increase>25% or >44µmol/L), recovery of renal function, the need for dialysis, and hospital costs within two months follow-up. RESULTS: Mean relative creatinine increase was 3.1% (95%CI 0.9 to 5.2%) in the bicarbonate and 1.1% (95%CI -1.2 to 3.5%) in the saline arm, mean difference 1.9% (95%CI -1.2 to 5.1%, p-non-inferiority <0.001). CI-AKI occurred in 11 (6.7%) patients randomized to sodium bicarbonate and 12 (7.5%) to saline (p = 0.79). Renal function did not fully recover in 40.0% and 44.4% of CI-AKI patients, respectively (p = 0.84). No patient required dialysis. Mean costs for preventive hydration and clinical preparation for the contrast procedure were $1158 for sodium bicarbonate vs. $1561 for saline (p < 0.001). CONCLUSION: Short hydration with sodium bicarbonate prior to elective cardiovascular diagnostic or therapeutic contrast procedures is non-inferior to standard periprocedural saline hydration in CKD patients with respect to renal safety and results in considerable healthcare savings. TRIAL REGISTRATION: Netherlands Trial Register (http://www.trialregister.nl/trialreg/index.asp), Nr NTR2699. |
| [Mh] Termos MeSH primário: |
Lesão Renal Aguda/prevenção & controle
Sistema Cardiovascular/diagnóstico por imagem
Meios de Contraste/efeitos adversos
Falência Renal Crônica/terapia
Bicarbonato de Sódio/administração & dosagem
Cloreto de Sódio/administração & dosagem
|
| [Mh] Termos MeSH secundário: |
Lesão Renal Aguda/induzido quimicamente
Idoso
Idoso de 80 Anos ou mais
Feminino
Seres Humanos
Masculino
Meia-Idade
|
| [Pt] Tipo de publicação: | JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL; RESEARCH SUPPORT, NON-U.S. GOV'T |
[Nm] Nome de substância:
| 0 (Contrast Media); 451W47IQ8X (Sodium Chloride); 8MDF5V39QO (Sodium Bicarbonate) |
| [Em] Mês de entrada: | 1803 |
| [Cu] Atualização por classe: | 180309 |
[Lr] Data última revisão:
| 180309 |
| [Sb] Subgrupo de revista: | IM |
| [Da] Data de entrada para processamento: | 180209 |
| [St] Status: | MEDLINE |
| [do] DOI: | 10.1371/journal.pone.0189372 |
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