Five-Year Follow-Up of Patients With Radio-Contrast-Induced Acute Renal Injury: Can Intravenous Sodium Bicarbonate Improve Long-Term Outcomes?

BACKGROUND/PURPOSE: Radiocontrast-induced acute kidney injury (RAKI) is a frequent complication during angiography and is associated with adverse prognosis. Most of the studies evaluating the long-term outcome of patients with RAKI are based on institutional registries. This is the first prospective study to evaluate the 5-year outcomes of patients with RAKI, and assess the effect of sodium bicarbonate (SB) in the long-term outcomes of patients with chronic kidney disease (CKD) undergoing non-emergent coronary angiography. MATERIALS/METHODS: 382 CKD stage III-IV patients undergoing elective non-emergent coronary angiography were randomized to SB (n = 192) or normal saline (NS) solution (n = 190). Incidence of RAKI, in-hospital, 1- and 5-year mortality and renal replacement therapy (RRT), and 5-year major adverse renal and cardiovascular events (MARCE) were compared between groups. Outcomes of patient with and without RAKI were compared after five-years of prospective follow-up. Multivariate predictors of RAKI and death at 5-years were determined. RESULTS: The use of SB did not improve the incidence of RAKI, in-hospital outcomes, survival, and freedom from RRT or MARCE after 5-years of follow-up. Patients that developed RAKI had a significantly higher mortality at 1-year [8.9% Vs. 1.2%] and 5-years (36% Vs. 11%) (P < 0.01). CONCLUSIONS: Hydration with SB showed no benefit compared to NS in preventing RAKI. The use of SB was not superior to NS after 5-years of follow-up regarding MARCE, survival or freedom of RRT. Five-year mortality among patients who developed RAKI remains high, and further research is needed to find the best preventive strategy for this high-risk group of patients. SUMMARY: Radiocontrast-induced acute-kidney-injury (RAKI) is associated with poor long-term outcomes in observational and short-term studies. Hydration with sodium bicarbonate (SB) had been evaluated in the prevention of RAKI; but its long-term effect has not been evaluated. We randomized 382 high high-risk patients undergoing coronary angiography to SB or normal saline following them for five years. SB showed no benefit in preventing RAKI, decreasing major adverse renal and cardiovascular events, improving survival or freedom from dialysis after 5-years. This is the first study to follow patients with RAKI for a period of 5-years, showing a significantly higher mortality in this group of patients.

Home blood pressure monitoring: how good a predictor of long-term risk?

Most management decisions for the diagnosis and treatment of hypertension are made using blood pressure (BP) measurements made in the clinic. However, home BP recordings may be of superior prognostic value. In this review, we show that home BP recordings are generally superior to clinic BP measurements in predicting long-term prognosis. Home BP has been shown to significantly predict important end points including all-cause mortality, progression of chronic kidney disease, and functional decline in the elderly. In addition, home BP recordings significantly and strongly predict cardiovascular events. These findings are robust, as they concur despite having been studied in disparate populations, using heterogeneous methods of clinic and home BP measurement, and with varied methods of statistical analysis. The advantages of home BP recordings are not due solely to a larger number of measurements, and they extend to the elderly, patients with chronic kidney disease, and those on hemodialysis. Because home BP recordings combine improved accuracy with the advantages of low cost and easy implementation, most patients with known or suspected hypertension should have their BP assessed and managed by means of home BP recordings.

A simple synthesis of 2-thiohydantoins.

2-Thiohydantoin derivatives are produced by heating a mixture of thiourea and an alpha-amino acid. The method described offers the advantages of simplicity, low cost, easy work-up and scalability.

Facile preparation of peracetates and per-3-bromobenzoates of alpha-mono- and disaccharides.

A simple and convenient method for the preparation of fully acetylated and (3- bromo)benzoylated alpha-monosaccharides and disaccharides through vigorous mechanical mixing of solid reactants on a high speed shaker is described. Using this technique a variety of alpha-acylated sugars are prepared, including penta-O-acetyl-alpha-D-galactopyranose, penta-O- acetyl-alpha-D-glucopyranose, penta-O-acetyl-alpha-D-mannopyranose, octa-O-acetyl-alpha-lactose, penta-O-(3-bromo)benzoyl-alpha-D-galactopyranose, penta-O-(3-bromo)benzoyl-alpha-D-gluco- pyranose, penta-O-(3-bromo)benzoyl-alpha-D-mannopyranose, and octa-O-(3-bromo)benzoyl- alpha-lactose.