Abstract 17596: Preliminary Results from EUglycemia for Renal Impairement Prevention After Contrast-medium Exposure (EURIPE) Randomized Study
Introduction: Up-to-date, the gold standard for Contrast Induced-Acute Kidney Injury (CI-AKI) prevention is hydration with isotonic saline solution (ISS), whereas, the role of several protective agents, such as N-Acetyl-Cysteine (NAC) has been largely discussed, with conflicting results. Poor glycemic control has also been associated with increased incidence of CI-AKI.
Hypothesis: Thus, we aimed to evaluate the efficacy of glucose-insulin-potassium (GIK) and NAC, in addition to ISS, for the prevention of renal contrast damage, assessed by serum Creatinine (sCr) and plasmatic Neutrophil Gelatinase-Associated Lipocalin (pNGAL) elevation, in patients undergoing percutaneous coronary intervention (PCI).
Methods: To date, 102 diabetic and/or with chronic renal failure patients were randomized to 3 different protocols: ISS-GIK-NAC (group 1), ISS-GIK (group 2), ISS (group 3). ISS and GIK infusion started 12 hours before PCI and maintained up to 12 hours after the procedure. NAC was given before PCI (2400 mg). We measured sCr (102 patients) and pNGAL (48 patients) levels before and after PCI. CI-AKI was defined as an increase of sCr ≥ 25% from baseline within 48 hours after contrast use.
Results: We observed a significant reduction of sCr after PCI in group 1 and 2, whereas, a slight increase was found in group 3 (-4% in group 1 and 2 and +3% in group 3) (group 1 vs group 3, p=0.01; group 2 vs group 3, p=0.01; p for trend = 0.01). The overall incidence of CI-AKI was 4%, with all the 4 cases in the group 3. Moreover, a significant post-PCI pNGAL attenuation was observed in the overall population; in detail, we measured a pNGAL decrease of -19±20 % in group 1 (p=0.032 vs ISS), of -6±23 % in group 2 (p=0.168 vs ISS), and a pNGAL increase of +15±51 % in group 3 (p for trend=0.067).
Conclusions: these preliminary results showed a significant post-PCI reduction of sCr and pNGAL in patients with GIK infusion and NAC administration, in addition to ISS. Our hypothesis is that maintaining a peri-procedural euglycemic state, jointly with the anti-oxidant action of NAC, may play a favorable role in preventing contrast-induced renal damage in diabetic and with chronic renal failure patients undergoing PCI. However, a larger population needs to confirm these preliminary findings.
Author Disclosures: A. Nusca: None. C. Campanale: None. C. Proscia: None. F. Lassandro Pepe: None. L. Ammirati: None. R. Contuzzi: None. G. Di Sciascio: None.
- © 2014 by American Heart Association, Inc.