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중탄산염 수액요법과 N-acetylcysteine의 조영제 신독성 예방효과

Intravenous Sodium Bicarbonate and Oral N-acetylcysteine for the Prevention of Contrast-Induced Nephropathy

김근호|김지현|이제|신진호|김경수|최보율|박준성|이창화|강종명|구태연
대한내과학회 (The Korean Association Of Internal Medicine)|2011.05|대한내과학회지 (The Korean Journal of Medicine)|제80권 제5호|pp. 537-545

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키워드

Contrast mediaM.D.Sodium chlorideSeongdong-guSodium bicarbonate조영제; 급성신부전; 식염수; 중탄산염; 아세틸시스테인Acute kidney failurePh.D.Department of Internal MedicineHanyang University College of Medicine17 Haengdang-dongSeoul 133-792KoreaTel: +82-2-2290-8318Fax: +82-2-2298-9183E-mail: kimgh@hanyang.ac.kr * This study was supported by a grant from Daewoong Pharmaceutical Co.
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초록

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. (Korean J Med 2011;80:537-545)

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. (Korean J Med 2011;80:537-545)

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