***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: We sought to clarify whether a single-bolus intravenous administration of sodium bicarbonate in addition to hydration with sodium chloride prevents contrast-induced nephropathy ( CIN ) . One hundred forty-four patients with mild renal insufficiency ( serum creatinine > 1.1 to < 2.0 mg/dl ) undergoing an elective coronary procedure were r and omly assigned to the following 2 groups : st and ard hydration with sodium chloride plus single-bolus intravenous administration of sodium bicarbonate ( 20 mEq ) immediately before contrast exposure ( group A , n = 72 ) and st and ard hydration alone ( group B , n = 72 ) . The primary end point was development of CIN , defined as an increase > 25 % or > 0.5 mg/dl in serum creatinine within 3 days after the procedure . Incidence of the primary end point was lower in group A than in group B ( 1.4 % vs 12.5 % , p = 0.017 ) . Incidence of adverse clinical events ( acute pulmonary edema , acute renal failure requiring dialysis , and death within 7 days of procedure ) did not differ between the 2 groups ( 0 % vs 1.4 % ) . In conclusion , single-bolus intravenous administration of sodium bicarbonate in addition to st and ard hydration can more effectively prevent CIN than st and ard hydration alone in patients with mild renal insufficiency undergoing an elective coronary procedure CONTEXT Contrast-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 . OBJECTIVE To examine the efficacy of sodium bicarbonate compared with sodium chloride for preventive hydration before and after radiographic contrast . DESIGN , SETTING , AND PATIENTS A prospect i ve , single-center , r and omized 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 ( > or = 97.2 micromol/L ) who were r and omized 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 . INTERVENTIONS Patients 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 MEASURE Contrast-induced nephropathy , defined as an increase of 25 % or more in serum creatinine within 2 days of contrast . RESULTS There 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 ] micromol/L ] for sodium chloride and 1.89 [ 0.69 ] mg/dL [ 167.1 [ 61.0 ] micromol/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 result ed in 3 cases of contrast-induced nephropathy ( 1.6 % ; 95 % CI , 0%-3.4 % ) . CONCLUSION Hydration with sodium bicarbonate before contrast exposure is more effective than hydration with sodium chloride for prophylaxis of contrast-induced renal failure BACKGROUND Several protective therapies have been developed to prevent contrast-induced nephropathy ( CIN ) . We aim ed to investigate the efficacy of sodium bicarbonate by comparing 2 other regimens , including combination of N-acetylcysteine ( NAC ) plus sodium chloride and sodium chloride alone , to prevent CIN in patients undergoing cardiovascular procedures . METHODS We prospect ively enrolled 264 patients who were scheduled for cardiovascular procedures and had a baseline creatinine level > 1.2 mg/dL. The patients were assigned 1 of 3 prophylactic regimens : infusion of sodium bicarbonate , sodium chloride , sodium chloride plus oral NAC ( 600 mg bid ) . Contrast-induced nephropathy was defined as an increase in serum creatinine level > 25 % or 0.5 mg/dL after 48 hours . RESULTS There were no significant differences among groups regarding baseline demographic properties and nephropathy risk factors . The change in creatinine clearance was significantly better in the sodium bicarbonate group than other 2 groups ( P = .007 ) . The incidence of CIN was significantly lower in the sodium bicarbonate group ( 4.5 % ) compared with sodium chloride alone ( 13.6 % , P = .036 ) and tended to be lower than in the combination group ( 12.5 % , P = .059 ) . After adjusting the Mehran nephropathy risk score , the risk of CIN significantly reduced with sodium bicarbonate compared with sodium chloride alone ( adjusted risk ratio 0.29 , P = .043 ) . CONCLUSIONS Hydration with sodium bicarbonate provides better protection against CIN than the sodium chloride infusion does alone . Combination therapy of NAC plus sodium chloride did not offer additional benefit over hydration with sodium chloride alone BACKGROUND Contrast-induced nephropathy ( CIN ) continues to be a common cause of acute renal failure in high-risk patients undergoing radiocontrast studies . However , there is still a lack of consensus regarding the most effective measures to prevent CIN . METHODS ONE HUNDRED EIGHTEEN PATIENTS WITH DIABETES MELLITUS AND /OR RENAL INSUFFICIENCY , SCHEDULED FOR CORONARY ANGIOGRAPHY OR INTERVENTION , WERE R AND OMLY ASSIGNED TO ONE OF FOUR TREATMENT GROUPS : intravenous ( IV ) 0.9 % NaCl alone , IV 0.9 % NaCl plus N-acetylcysteine ( NAC ) , IV 0.9 % sodium bicarbonate ( NaHCO(3 ) ) alone or IV 0.9 % NaHCO(3 ) plus NAC . All patients received IV hydration as a preprocedure bolus and as maintenance . Iso-osmolar contrast was used in all patients . CIN was defined as an increase of greater than 25 % in the serum creatinine concentration from baseline to 72 h. RESULTS The overall incidence of CIN was 6 % . There was no statistically significant difference in the incidence of CIN among the groups . There was a CIN incidence of 7 % in the NaCl only group , 5 % in the NaCl/NAC group , 11 % in the NaHCO(3 ) only group and 4 % in the NaHCO(3)/NAC group ( P=0.86 ) . The maximum increase in serum creatinine was 14.14±12.38 μmol/L in the NaHCO(3 ) group , 10.60±29.14 μmol/L in the NaCl only group , 9.72±13.26 μmol/L in the NaCl/NAC group and 0.177±15.91 μmol/L for the NaHCO(3)/NAC group ( P=0.0792 ) . CONCLUSION CIN in high-risk patients may be effectively minimized solely through the use of an aggressive hydration protocol and an iso-osmolar contrast agent . The addition of NaHCO(3 ) and /or NAC did not have an effect on the incidence of CIN Despite myriad improvements in the care of hospitalized patients , a decline in renal function remains a common event . Renal function in 4,622 consecutive patients admitted to the medical and surgical services of an urban tertiary care hospital was followed up prospect ively from the time of admission . Some degree of renal insufficiency developed in 7.2 % of patients . Decreased renal perfusion , medications , surgery , and radiographic contrast media were the most common causes of hospital-acquired renal insufficiency ( HARI ) . The overall mortality rate was 19.4 % and was similar among patients for all causes of renal insufficiency , except sepsis . For patients with a greater than 3.0-mg/dL increase in serum creatinine level , the mortality rate was 37.8 % . As shown by previous investigators , age and preexisting renal insufficiency were risk factors for HARI . Women and blacks had less hospital-acquired renal failure . The increasing acuity of hospital admissions has been accompanied by a greater incidence of acute renal insufficiency in patients admitted to hospitals . There is a trend toward better survival in patients with a severe deterioration in renal function AIMS The most effective regimen for the prevention of  contrast-induced nephropathy ( CIN )  remains uncertain . Our purpose was to compare two regimens of sodium bicarbonate with 24 h sodium chloride 0.9 % infusion in the prevention of CIN . METHODS AND RESULTS We performed a prospect i ve , r and omized trial between March 2005 and December 2009 , including 258 consecutive patients with renal insufficiency undergoing intravascular contrast procedures . Patients were r and omized to receive intravenous volume supplementation with either ( A ) sodium chloride 0.9 % 1 mL/kg/h for at least 12h prior and after the procedure or ( B ) sodium bicarbonate ( 166 mEq/L ) 3 mL/kg for 1 h before and 1 mL/kg/h for 6 h after the procedure or ( C ) sodium bicarbonate ( 166 mEq/L ) 3 mL/kg over 20 min before the procedure plus sodium bicarbonate orally ( 500 mg per 10 kg ) . The primary endpoint was the change in estimated glomerular filtration rate ( eGFR ) within 48 h after contrast . Secondary endpoints included the development of CIN . The maximum change in eGFR was significantly greater in Group B compared with Group A { mean difference -3.9 [ 95 % confidence interval ( CI ) , -6.8 to -1 ] mL/min/1.73 m2 , P = 0.009 } and similar between groups C and B [ mean difference 1.3 ( 95 % CI , -1.7 - 4.3 ) mL/min/1.73 m(2 ) , P = 0.39 ] . The incidence of CIN was significantly lower in Group A ( 1 % ) vs. Group B ( 9 % , P = 0.02 ) and similar between Groups B and C ( 10 % , P = 0.9 ) . CONCLUSION Volume supplementation with 24 h sodium chloride 0.9 % is superior to sodium bicarbonate for the prevention of CIN . A short-term regimen with sodium bicarbonate is non-inferior to a 7 h regimen . Clinical Trials.gov Identifier : NCT00130598 OBJECTIVES This study was design ed to determine the effectiveness of a protocol for rapid intravenous hydration to prevent contrast-induced nephropathy ( CIN ) in patients undergoing emergency percutaneous coronary intervention ( PCI ) . BACKGROUND Contrast-induced nephropathy frequently complicates PCI , result ing in prolonged hospitalization and increased in-hospital and long-term morbidity and mortality . Little is known regarding prevention of CIN in patients undergoing urgent PCI . METHODS We conducted a prospect i ve , controlled , r and omized , single-center trial in 111 consecutive patients with acute coronary syndrome undergoing emergency PCI . As part of the hydration therapy , 56 patients ( group A ) received an infusion of sodium bicarbonate plus N-acetylcysteine ( N-AC ) started just before contrast injection and continued for 12 h after PCI . The remaining 55 patients ( group B ) received the st and ard hydration protocol consisting of intravenous isotonic saline for 12 h after PCI . In both groups , 2 doses of oral N-AC were administered the next day . 
    Output:
    
Overall , hydration with sodium bicarbonate could significantly reduce CIN and the length of hospital stay compared to sodium chloride .
In addition NAC added as a supplement to sodium bicarbonate could increase prophylactic effects against nephropathy