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Treatment Reduces Contrast-Induced Kidney Injury

Prophylactic protocol of N-acetylcysteine and sodium bicarbonate in catheterizations advised

WEDNESDAY, Nov. 18 (HealthDay News) -- A prophylactic protocol using a combination of N-acetylcysteine (NAC) and sodium bicarbonate should be implemented to prevent acute kidney injury (AKI) resulting from contrast agents used in cardiac catheterizations and percutaneous coronary interventions, according to a meta-analysis reported in the November issue of the Journal of the American College of Cardiology: Cardiovascular Interventions.

Jeremiah R. Brown, Ph.D., of the Dartmouth Institute for Health Policy and Clinical Practice in Lebanon, N.H., and colleagues reviewed the medical literature evaluating the use of NAC and sodium bicarbonate for AKI prevention. The reviewers screened 49 trials and identified 10 published between 2006 and 2009 in which the primary outcome was contrast-induced AKI (defined as a ≥25 percent or ≥0.5 mg/dL increase in serum creatinine), and the secondary outcome was kidney failure necessitating dialysis.

The reviewers performed meta-analysis on pooled data for the 10 studies and found combination treatment using NAC and intravenous sodium bicarbonate resulted in a 35 percent reduction of contrast-induced AKI, but did not significantly reduce kidney failure necessitating dialysis.

"Combination prophylaxis should be incorporated for all high-risk patients (emergent cases or patients with chronic kidney disease) and should be strongly considered for all interventional radio-contrast procedures," the authors write.

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