Author
Robert A. Rittase
Bio: Robert A. Rittase is an academic researcher. The author has contributed to research in topics: Sodium bicarbonate & Contrast-induced nephropathy. The author has an hindex of 3, co-authored 4 publications receiving 1105 citations.
Papers
More filters
TL;DR: Hydration with sodium bicarbonate before contrast exposure is more effective than hydration with Sodium chloride for prophylaxis of contrast-induced renal failure.
Abstract: ContextContrast-induced nephropathy remains a common complication of radiographic
procedures. Pretreatment with sodium bicarbonate is more protective than sodium
chloride in animal models of acute ischemic renal failure. Acute renal failure
from both ischemia and contrast are postulated to occur from free-radical
injury. However, no studies in humans or animals have evaluated the efficacy
of sodium bicarbonate for prophylaxis against contrast-induced nephropathy.ObjectiveTo examine the efficacy of sodium bicarbonate compared with sodium chloride
for preventive hydration before and after radiographic contrast.Design, Setting, and PatientsA prospective, single-center, randomized trial conducted from September
16, 2002, to June 17, 2003, of 119 patients with stable serum creatinine levels
of at least 1.1 mg/dL (≥97.2 µmol/L) who were randomized to receive
a 154-mEq/L infusion of either sodium chloride (n = 59) or sodium bicarbonate
(n = 60) before and after iopamidol administration (370 mg iodine/mL). Serum
creatinine levels were measured at baseline and 1 and 2 days after contrast.InterventionsPatients received 154 mEq/L of either sodium chloride or sodium bicarbonate,
as a bolus of 3 mL/kg per hour for 1 hour before iopamidol contrast, followed
by an infusion of 1 mL/kg per hour for 6 hours after the procedure.Main Outcome MeasureContrast-induced nephropathy, defined as an increase of 25% or more
in serum creatinine within 2 days of contrast.ResultsThere were no significant group differences in age, sex, incidence of
diabetes mellitus, ethnicity, or contrast volume. Baseline serum creatinine
was slightly higher but not statistically different in patients receiving
sodium bicarbonate treatment (mean [SD], 1.71 [0.42] mg/dL [151.2 {37.1} µmol/L]
for sodium chloride and 1.89 [0.69] mg/dL [167.1 {61.0} µmol/L] for
sodium bicarbonate; P = .09). The primary end point
of contrast-induced nephropathy occurred in 8 patients (13.6%) infused with
sodium chloride but in only 1 (1.7%) of those receiving sodium bicarbonate(mean
difference, 11.9%; 95% confidence interval [CI], 2.6%-21.2%; P = .02). A follow-up registry of 191 consecutive patients receiving
prophylactic sodium bicarbonate and meeting the same inclusion criteria as
the study resulted in 3 cases of contrast-induced nephropathy (1.6%; 95% CI,
0%-3.4%).ConclusionHydration with sodium bicarbonate before contrast exposure is more effective
than hydration with sodium chloride for prophylaxis of contrast-induced renal
failure.
1,033 citations
TL;DR: An evidence-based protocol for prevention of contrast-induced nephropathy is presented that uses infusion of NaHCO3 to effect urinary alkalinization and possibly decrease free-radical renal injury resulting from contrast exposure.
Abstract: Contrast-induced nephropathy has continued to plague interventional cardiology as an all-too-frequent complication of diagnostic and therapeutic procedures. We present an evidence-based protocol for prevention of this complication that uses infusion of NaHCO3 to effect urinary alkalinization and possibly decrease free-radical renal injury resulting from contrast exposure.
28 citations
TL;DR: The hypothesis set forth in the original bicarbonate hydration article referred to the establishment of a relatively neutral pH in the medullary portion of the kidney prior to contrast exposure with its subsequent complex cascade of events leading to free radical formation and CIN, with a study in children by Assadi suggests that even the doses used by Merten et al may well have been less than optimal.
Abstract: To the Editor: In their randomized trial comparing sodium bicarbonate vs sodium chloride for prevention of contrast medium–induced nephropathy (CIN), Dr Brar and colleagues used a lower dose of bicarbonate than described in other studies and found that this lower dose of bicarbonate was inadequate to significantly reduce CIN. Their study did not document urine pH as was done in other studies. The bicarbonate concentration in their study was 130 mEq/L compared with 154 mEq/L in the other studies. The administered dose of bicarbonate anion was higher in the studies by Merten et al (by 18%), Ozcan et al (by 58%), and Recio-Mayoral et al (by 202%). The higher doses would likely result in a higher urine pH, although the bicarbonate effect on urine pH is nonlinear. The hypothesis set forth in the original bicarbonate hydration article referred to the establishment of a relatively neutral pH in the medullary portion of the kidney prior to contrast exposure with its subsequent complex cascade of events leading to free radical formation and CIN. A study in children by Assadi suggests that even the dose of bicarbonate used by Merten et al may well have been less than optimal, with the urine pH in this pediatric study correlating inversely with CIN. The cohort of 46 children (mean weight, 44 kg; mean serum creatinine level, 1.43 mg/dL) with higher urine pH (7.8) resulting from acetazolamide administration had a 0% incidence of CIN compared with the randomized cohort of 50 children receiving the protocol used by Merten et al (urine pH, 6.4; CIN incidence, 8.7%; P=.049). The study by Merten et al reported a urine pH of 6.5. Despite the lower bicarbonate dose, the study by Brar et al did show that the majority of outcome measures were improved with bicarbonate, but these results were not statistically significant. The outcome of CIN in 21 patients with the highest risk (estimated glomerular filtration rate 30 mL/min per 1.73 m) was 36% in the bicarbonate group compared with 20% in the saline group (P=.64). A larger sample size may have resulted in a statistically significant difference. Future studies that use bicarbonate hydration should include an outcome measure of the effectiveness of the bicarbonate dose (urine pH) and use an adequate alkalinizing dose to achieve a neutral urine pH. William Burgess, MD, PhD patburgess@mdsci.com Gregory J. Merten, MD Robert A. Rittase, PharmD Department of Internal Medicine Carolinas Medical Center Charlotte, North Carolina
2 citations
Cited by
More filters
TL;DR: The current guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation are based on the findings of the ESC Task Force on 12 March 2015.
Abstract: ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation : The Task Force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC).
6,866 citations
TL;DR: The guidelines focused on 4 key domains: (1) AKI definition, (2) prevention and treatment of AKI, (3) contrastinduced AKI (CI-AKI) and (4) dialysis interventions for the treatment ofAKI.
Abstract: tion’, implying that most patients ‘should’ receive a particular action. In contrast, level 2 guidelines are essentially ‘suggestions’ and are deemed to be ‘weak’ or discretionary, recognising that management decisions may vary in different clinical contexts. Each recommendation was further graded from A to D by the quality of evidence underpinning them, with grade A referring to a high quality of evidence whilst grade D recognised a ‘very low’ evidence base. The overall strength and quality of the supporting evidence is summarised in table 1 . The guidelines focused on 4 key domains: (1) AKI definition, (2) prevention and treatment of AKI, (3) contrastinduced AKI (CI-AKI) and (4) dialysis interventions for the treatment of AKI. The full summary of clinical practice statements is available at www.kdigo.org, but a few key recommendation statements will be highlighted here.
6,247 citations
TL;DR: Authors/Task Force Members: Franz-Josef Neumann* (ESC Chairperson) (Germany), Miguel Sousa-Uva* (EACTS Chair person) (Portugal), Anders Ahlsson (Sweden), Fernando Alfonso (Spain), Adrian P. Banning (UK), Umberto Benedetto (UK).
4,342 citations
TL;DR: Neumann et al. as discussed by the authors proposed a task force to evaluate the EACTS Review Co-ordinator's work on gender equality in the context of women's reproductive health.
Abstract: Authors/Task Force Members: Franz-Josef Neumann* (ESC Chairperson) (Germany), Miguel Sousa-Uva* (EACTS Chairperson) (Portugal), Anders Ahlsson (Sweden), Fernando Alfonso (Spain), Adrian P. Banning (UK), Umberto Benedetto (UK), Robert A. Byrne (Germany), Jean-Philippe Collet (France), Volkmar Falk (Germany), Stuart J. Head (The Netherlands), Peter Jüni (Canada), Adnan Kastrati (Germany), Akos Koller (Hungary), Steen D. Kristensen (Denmark), Josef Niebauer (Austria), Dimitrios J. Richter (Greece), Petar M. Seferovi c (Serbia), Dirk Sibbing (Germany), Giulio G. Stefanini (Italy), Stephan Windecker (Switzerland), Rashmi Yadav (UK), Michael O. Zembala (Poland) Document Reviewers: William Wijns (ESC Review Co-ordinator) (Ireland), David Glineur (EACTS Review Co-ordinator) (Canada), Victor Aboyans (France), Stephan Achenbach (Germany), Stefan Agewall (Norway), Felicita Andreotti (Italy), Emanuele Barbato (Italy), Andreas Baumbach (UK), James Brophy (Canada), Héctor Bueno (Spain), Patrick A. Calvert (UK), Davide Capodanno (Italy), Piroze M. Davierwala
3,879 citations
TL;DR: Guidelines and Expert Consensus Documents summarize and evaluate all available evidence to assist physicians in selecting the best management strategy for an individual patient suffering from a given condition, taking into account the impact on outcome and the risk–benefit ratio of diagnostic or therapeutic means.
Abstract: Guidelines and Expert Consensus Documents summarize and evaluate all available evidence with the aim of assisting physicians in selecting the best management strategy for an individual patient suffering from a given condition, taking into account the impact on outcome and the risk–benefit ratio of diagnostic or therapeutic means. Guidelines are no substitutes for textbooks and their legal implications have been discussed previously. Guidelines and recommendations should help physicians to make decisions in their daily practice. However, the ultimate judgement regarding the care of an individual patient must be made by his/her responsible physician(s).
The recommendations for formulating and issuing ESC Guidelines and Expert Consensus Documents can be found on the ESC website (http://www.escardio.org/knowledge/guidelines/rules).
Members of this Task Force were selected by the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) to represent all physicians involved with the medical and surgical care of patients with coronary artery disease (CAD). A critical evaluation of diagnostic and therapeutic procedures is performed including assessment of the risk–benefit ratio. Estimates of expected health outcomes for society are included, where data exist. The level of evidence and the strength of recommendation of particular treatment options are weighed and graded according to predefined scales, as outlined in Tables 1 and 2 .
View this table:
Table 1
Classes of recommendations
View this table:
Table 2
Levels of evidence
The members of the Task Force have provided disclosure statements of all relationships that might be perceived as real or potential sources of conflicts of interest. These disclosure forms are kept on file at European Heart House, headquarters of the ESC. Any changes in conflict of interest that arose during the writing period were notified to the ESC. The Task Force report received its entire financial support from the ESC and EACTS, without any involvement of the pharmaceutical, device, or surgical industry.
ESC …
3,302 citations