A prospective study on prevention of contrast – induced nephropathy in Croatia

Sa？etak Aim: To explore the protective role of hydration, urine alkalization (Na bicarbonate) and high doses of antioxidant (N-acetylcysteine) in the prevention of CIN. Material and methods: In a prospective, randomized, single-blinded study patients were divided into three groups: 1) peroral hydration, 2) Na bicarbonate infusion and 3) N-acetylcysteine (NAC) plus NaHCO3 infusion. Serum creatinine (SCr), blood urea nitrogen (BUN), and neutrophil gelatinase-associated lipocalin (NGAL) were measured before and 48 hours after the angiography. Mehran score was calculated for each patient. Results: The study included 106 patients. Groups were comparable regarding the baseline characteristics. According to Mehran risk score 70 % of patients had a low risk, 24% medium and 6% high risk score for development of CIN. After the procedure renal function was preserved in all patients (SCr 103(87.0-121.5), BUN 5.8 (4.9-7.6), creatinine clearance 74.7(55.3-97.6), NGAL 11.4(5.4-19.9)) regardless of the Mehran risk score. The follow up was completed for 73 patients (68 %). Twenty two patients (32 %) developed chronic kidney disease, mostly classified as G3a and G3b according to KDIGO guidelines. Chronic kidney disease developed in patients with the positive history of diabetes and in patients who had higher Mehran score before the diagnostic procedure. Conclusion: The study showed that patients with preserved renal function are not prone to CIN. Regardless of the protocol used, no case of CIN was observed. Our results indicate that adequate hydration is a key component in maintaining the renal function. Higher Mehran score might be useful in predicting the development of chronic kidney disease