Podcast Episodes

The Efficacy of Sodium Bicarbonate and Acetylcysteine After Angiography

Joel Topf, M.D. interviews Steven D. Weisbord, M.D., lead researcher on a study recently published in the New England Journal of Medicine.

Title:

Outcomes after Angiography with Sodium Bicarbonate and Acetylcysteine

Authors:

Steven D. Weisbord, M.D., Martin Gallagher, M.D., Ph.D., Hani Jneid, M.D., Santiago Garcia, M.D., Alan Cass, M.D., Ph.D., Soe-Soe Thwin, Ph.D., Todd A. Conner, Pharm.D., Glenn M. Chertow, M.D., M.P.H., Deepak L. Bhatt, M.D., M.P.H., Kendrick Shunk, M.D., Ph.D., Chirag R. Parikh, M.D., Ph.D., Edward O. McFalls, M.D., PhD., Mary Brophy, M.D., M.P.H., Ryan Ferguson, D.Sc., M.P.H., Hongsheng Wu, Ph.D., Maria Androsenko, M.S., John Myles, M.P.H., James Kaufman, M.D., and Paul M. Palevsky, M.D., for the PRESERVE Trial Group*

Background:

Acute kidney injury associated with the administration of contrast material during angiography can result in death, accelerated progression of underlying chronic kidney disease, and the need for dialysis, along with substantial increases in health care costs.

The periprocedural administration of intravenous isotonic sodium chloride has been the standard intervention to prevent this complication.

On the basis of hypotheses that urinary alkalinization and scavenging of reactive oxygen species mitigate renal tubular epithelial-cell injury from the use of iodinated contrast material, multiple studies have compared intravenous sodium bicarbonate with intravenous sodium chloride and have evaluated treatment with acetylcysteine for the prevention of contrast-associated acute kidney injury, with inconsistent results.

Consequently, equipoise exists regarding these interventions, despite their widespread use in clinical practice. We designed the Prevention of Serious Adverse Events Following Angiography (PRESERVE) trial to compare intravenous sodium bicarbonate with intravenous sodium chloride and oral acetylcysteine with oral placebo for the prevention of major adverse outcomes and acute kidney injury in a large population of high-risk patients undergoing coronary or noncoronary angiography.

Full article at: http://www.nejm.org/doi/full/10.1056/NEJMoa1710933#t=articleTop