For patients with chronic renal insufficiency (gfr<60) undergoing coronary angiography, previous small RCTs showed bicarbonate to be superior to saline (abstract) (abstract) (abstract) in preventing CIN, but in a subsequent larger RCT, it was not found to be superior (when combined with N-acetylcysteine) (abstract). A recent meta-analysis found bicarbonate to be superior to saline, but noted signficant study heterogeneity and likely publication bias, calling for a larger RCT (meta-analysis). Now we have a larger RCT, in which 353 high risk patients (gfr <60 with DM, CHF, HTN, or age >75) were randomized to saline or bicarbonate infusions, and N-acetylcysteine was given at the discretion of the treating physician (in about half of patients). There was no difference in incidence of CIN between the groups (even when stratified by DM or receipt of N-acetylcysteine). In summary, it is unlikely that bicarbonate infusions are more beneficial than saline in preventing CIN (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 […]