Strategies to Reduce Acute Kidney Injury in Angioplasty

The title of this article leads us to think that we will find a list of things that we can do to reduce kidney injury. However, (unfortunately) sodium bicarbonate showed no benefit over saline and n-acetylcysteine showed no benefit over a placebo for the reduction of kidney damage after coronary angioplasty.

Among the protective measures most frequently tested are endovenous sodium bicarbonate and oral n-acetylcysteine, both with conflicting results.

The PRESERVE (Prevention of Serious Adverse Events Following Angiography) trial used a 2 × 2 factorial design and randomized 5177 patients with stage III or IV renal insufficiency requiring angiography to 1.26% sodium bicarbonate or 0.9% sodium chloride and n-acetylcysteine or placebo for 5 days. The primary endpoint was a composite of death, need for dialysis, or persistent renal insufficiency at 90 days. Contrast-associated acute kidney injury was a secondary endpoint.

Read also: Contrast Induced Kidney Injury, Infamous Problem with No Magical Solutions.

A total of 1161 study patients underwent coronary angioplasty. The mean glomerular filtration rate was 50.7 mL/min/1.73 m2 and 82% of the population had a history of diabetes.

The primary endpoint occurred in 2.6% of patients who received sodium bicarbonate vs. 4% of patients who received saline (p = 0.41) and in 3.8% of patients who received n-acetylcysteine vs. 2.8% of patients who received a placebo (p = 0.29). There were no significant differences among groups as regards the incidence of contrast-associated kidney injury.

Conclusion

Among patients with chronic kidney disease who underwent angioplasty, there was no benefit of sodium bicarbonate over regular saline or of n-acetylcysteine over placebo for the prevention of contrast-associated kidney injury.

Original title: Strategies to Reduce Acute Kidney Injury and Improve Clinical Outcomes Following Percutaneous Coronary Intervention. A Subgroup Analysis of the PRESERVE Trial.

Reference: Santiago Garcia et al. J Am Coll Cardiol Intv 2018;11:2254-61.

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