Joel Topf, M.D. interviews Steven D. Weisbord, M.D., lead researcher on
a study recently published in the New England Journal of Medicine.
Outcomes after Angiography with Sodium Bicarbonate and Acetylcysteine
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
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.
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