Prevenção da nefrotoxicidade por contraste em pacientes oncológicos: comparação de hidratação com solução a base de cloreto de sódio e bicarbonato de sódio / Prevention of contrast-induced nephropathy in oncology patients. Hydration with 0.9% sodium chloride compared to sodium bicarbonate

AUTOR(ES)
DATA DE PUBLICAÇÃO

2009

RESUMO

The incidence of contrast nephropathy has increased simultaneously to the augment of the use of diagnostic and interventional imaging procedures. Unfortunately, a large number of physicians do not know its existence and even when so do, sometimes do not do not know the risk factors associated to its development. The incidence of contrast nephropathy in the general population is low, but, if we consider only the patients with risk factors such as diabetes and chronic kidney disease, this incidence increases largely. Several strategies have been used in order to prevent contrast nephropathy. Among them, we include the use of vasodilators, calcium channel blockers, antioxidants, saline (0.9 or 0.45%), bicarbonate, low or iso osmolar iodinate contrast. The strategies that have proved better efficacy are saline hydration (0.9 or 0.45%), use of low or iso osmolar contrast and bicarbonate. N-acetylcysteine (an antioxidant agent), despite of the positive results obtained in the first trials, did not demonstrate the same efficacy subsequently. The aim of the current study was to review the pertinent literature and to assess the efficacy of sodium bicarbonate compared to saline in order to prevent contrast nephropathy. There were randomized 27 patients, 48% allocated in the bicarbonate group. All the patients were diabetic and/or had chronic kidney disease, and were diagnosed with some kind of cancer. No one of 27 patients developed contrast nephropathy (increase of 0.5 mg/dL in the baseline creatinine and/or a relative increase of 25% in baseline creatinine). The literature review strongly suggested that sodium bicarbonate use is valuable in then prevention of contrast nephropathy. In reference to the randomized study the small number of included patients did not allow that conclusive conclusions were obtained. However, in the group studied sodium bicarbonate demonstrated the same efficacy than saline in the prevention of contrast nephropathy.

ASSUNTO(S)

bicarbonate prevention bicarbonato de sódio contrast nephropathy solução fisiológica nefrotoxicidade prevenção nefropatia do contraste nephrotoxicity

ACESSO AO ARTIGO

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