%0 Journal Article
%T Bicarbonates for the Prevention of Postoperative Renal Failure in Endovascular Aortic Aneurysm Repair: A Randomized Pilot Trial
%A V谷ronique Brulotte
%A Franˋois A. Leblond
%A St谷phane Elkouri
%A 谷ric Th谷rasse
%A Vincent Pichette
%A Pierre Beaulieu
%J Anesthesiology Research and Practice
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/467326
%X Purpose. Contrast-induced nephropathy (CIN) can contribute to acute kidney injury (AKI) in patients undergoing endovascular aortic aneurysm surgery. We evaluated the incidence of AKI together with the evolution of early biomarkers of renal injury in patients receiving bicarbonates or NaCl 0.9%. Methods. This study involved endovascular aortic aneurysm surgery patients. Group A ( ) received bicarbonates 3ˋmL/kg/h for 1ˋh before the procedure and then 1ˋmL/kg/h until 6ˋh after surgery, whereas group B ( ) received NaCl 0.9% using the same protocol. Biomarkers of renal injury from urine (interleukin-18 (IL-18), neutrophil gelatinase-associated lipocalin (NGAL), N-acetyl- -D-glucosaminidase (NAG), and kidney injury molecule 1 (KIM-1)) and blood (NGAL, cystatin C) were measured at baseline and 3, 24, and 48ˋh postoperatively. Results. AKI occurred in 1 patient (2.9%), in the bicarbonates group. IL-18, NAG, NGAL, and KIM-1 significantly rose in both groups after the surgery. There was a greater rise in NGAL and IL-18 after 3ˋh in the bicarbonates versus NaCl 0.9% group: 1115% versus 240% increase ( ) and 338% increase versus 1.4% decrease ( ). Conclusions. Despite significant elevation in biomarkers of renal injury, we demonstrated a low rate of AKI following endovascular aortic surgery. 1. Introduction The endovascular approach for the repair of aortic aneurysm is an interesting alternative to the open repair approach because of its associated reduced 30-day morbidity and mortality. This approach, however, carries its own risks such as renal complications [1每5]. Renal complications occur with variable incidence, ranging from 5.5 to 20% [3每6]. They may be caused by ischemic or embolic events but can also be secondary to the large amounts of contrast media used to guide prosthesis placement. This complication is known as contrast-induced nephropathy (CIN). Indeed, the volume of contrast media used in vascular surgery is important, ranging from 130 to 260ˋmL [1, 3, 4, 6, 7]. Many strategies have been developed in an attempt to prevent CIN. Among these, an intravenous volume expansion that covers the pre-, per- and postcontrast media exposure is the only established way [8每13]. N-acetylcysteine (NAC) administration has been suggested because of its low cost, safety, and possible benefit in patients with chronic renal failure [14每19], although its efficacy is controversial [14]. What type of infusion to use to achieve intravenous volume expansion is not known [14每29]. By its ability to alkalinize renal tubular fluid and reduce the formation of free radicals,
%U http://www.hindawi.com/journals/arp/2013/467326/