In this randomized trial of patients with renal insufficiency undergoing procedures with IV contrast, they were randomized to normal saline (1cc/kg/hr for 12 hours before and after procedure), or Hco3 (2 different regimens; 3cc/kg an hour before and 1cc/kg/hr for 6 hours after, or 3cc/kg 20 minutes before and oral Hco3 after at 500mg/10kg). The saline group was significantly less likely than either Hco3 group to develop contrast induced nephropathy (1% vs 9% in both Hc03 groups) and had less change in gfr (abstract)
Synthetic marijuana, or “spice” has been linked to at least 16 cases of acute renal failure, according to the CDC. Unexplained renal failure in young otherwise healthy patients should prompt questioning about synthetic marijuana use (CDC site).
In this case-control study, patients on ACE/ARBs were significantly more likely than those not on ACE/ARBs to experience contrast-induced acute kidney injury (odds ratio 1.4, CI 1.1 to 1.8). However, this does not prove causality, and it is not clear that discontinuing ACE/ARBs before a contrast load would prevent the kidney injury (abstract).
In this large administrative database analysis of patients with non-valvular afib, patients with ESRD were significantly more likely to suffer stroke, system thromboembolism, and bleeding than those without ESRD; the risk of stroke/embolism was significantly lower for those on warfarin but not those on ASA, while the risk of bleeding was higher with both ASA […]