Arq Bras Cardiol abc Arquivos Brasileiros de Cardiologia Arq. Bras. Cardiol. 0066-782X 1678-4170 Sociedade Brasileira de Cardiologia - SBC qQmTtMWXGYJsQs4kBRDCcwt S0066-782X2023000200201 00201 10.36660/abc.20220868 Minieditorial A Hidratação Oral pode ser uma Opção na Prevenção da Nefropatia Induzida por Contraste em Intervenções Coronárias Eletivas 0000-0001-9631-946X Evora Paulo Roberto Barbosa 1 Universidade de São Paulo Faculdade de Medicina de Ribeirão Preto Ribeirão Preto SP Brasil Universidade de São Paulo – Faculdade de Medicina de Ribeirão Preto – Cirurgia e Anatomia, Ribeirão Preto, SP – Brasil Correspondência: Paulo Roberto Barbosa Evora • Avenida Bandeirantes, 3900, CEP 14049-900, Ribeirão Preto, SP – Brasil E-mail: prbevora@gmail.com 27 02 2023 2023 120 2 e20220868 This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Hidratação/métodos Nefropatias/prevenção e controle Hidratação Oral Hidratação Intravenosa Nicorandil/uso terapêutico Cateterismo Cardíaco/métodos

O estudo1 tem perfil editorial questionável dos ABC Cardiol e não apresenta nenhuma novidade. No entanto, sua decisão de publicação é útil para cardiologistas em sua atividade de controle pré-operatório. Sempre se fala em insuficiência renal aguda, e às vezes tem-se a impressão de que está sendo subestimada ou superestimada.

Esses protocolos incluem 1) Medicamentos; 2) alcalinização com bicarbonato de sódio, e; 3) hidratação. Dentre as diversas drogas, o nicorandil tem sido utilizado em pacientes com disfunção renal crônica. Um estudo realizado para avaliar seu efeito preventivo em pacientes de alto risco revelou eficácia substancial em relação ao protocolo de hidratação para cateterismo cardíaco.2 , 3 Dentre as diversas drogas, o nicorandil tem sido utilizado em pacientes com disfunção renal crônica.4 , 5

Concordamos com os autores1 que a medida preventiva mais eficaz até o momento é a hidratação intravenosa (IV). No entanto, as evidências atuais mostraram que a hidratação oral (HO) é comparável à infusão intravenosa, mas a sua aplicação ambulatorial ainda carece de mais investigações em procedimentos coronarianos eletivos.

O presente protocolo de HO parece ser semelhante ao protocolo de IV hospitalar na proteção renal. Os autores sugerem testá-lo em grandes ensaios na tentativa de provar que a HO é eficaz e seria de fácil adoção na prática médica.

Referências 1. Pioli MR, Couto RM, Francisco JA, Antoniassi DQ, Souza CR, Olivio MY, et al. Effectiveness of Oral Hydration in Preventing Contrast-Induced Nephropathy in Individuals Undergoing Elective Coronary Interventions. Arq Bras Cardiol. 2023; 120(2):e20220529. Pioli MR Couto RM Francisco JA Antoniassi DQ Souza CR Olivio MY et al Effectiveness of Oral Hydration in Preventing Contrast-Induced Nephropathy in Individuals Undergoing Elective Coronary Interventions Arq Bras Cardiol 2023 120 2 e20220529 2. Rudnick MR, Fay K, Wahba IM. Fluid administration strategies for the prevention of contrast-associated acute kidney injury. Curr Opin Nephrol Hypertens. 2022 Sep 1;31(5):414-24. doi: 10.1097/MNH.00000000000000815. Rudnick MR Fay K Wahba IM Fluid administration strategies for the prevention of contrast-associated acute kidney injury Curr Opin Nephrol Hypertens 2022 09 1 31 5 414 424 10.1097/MNH.00000000000000815 3. Zaki HA, Bashir K, Iftikhar H, Alhatemi M, Elmoheen A. Evaluating the Effectiveness of Pretreatment With Intravenous Fluid in Reducing the Risk of Developing Contrast-Induced Nephropathy: A Systematic Review and Meta-Analysis. Cureus. 2022 May 8;14(5):e24825. doi: 10.7759/cureus.24825. Zaki HA Bashir K Iftikhar H Alhatemi M Elmoheen A Evaluating the Effectiveness of Pretreatment With Intravenous Fluid in Reducing the Risk of Developing Contrast-Induced Nephropathy: A Systematic Review and Meta-Analysis Cureus 2022 05 8 14 5 e24825 10.7759/cureus.24825 4. Iranirad L, Hejazi SF, Sadeghi MS, Jang SA. Efficacy of nicorandil treatment for prevention of contrast-induced nephropathy in high-risk patients undergoing cardiac catheterization: A prospective randomized controlled trial. Cardiol J. 2017;24(5):502-7. doi: 10.5603/CJ.a2017.0028. Iranirad L Hejazi SF Sadeghi MS Jang SA Efficacy of nicorandil treatment for prevention of contrast-induced nephropathy in high-risk patients undergoing cardiac catheterization: A prospective randomized controlled trial Cardiol J 2017 24 5 502 507 10.5603/CJ.a2017.0028 5 Sebastià C, Páez-Carpio A, Guillen E, Paño B, Arnaiz JA, De Francisco AL, et al. Oral hydration as a safe prophylactic measure to prevent post-contrast acute kidney injury in oncologic patients with chronic kidney disease (IIIb) referred for contrast-enhanced computed tomography: subanalysis of the oncological group of the NICIR study. Support Care Cancer. 2022 Feb;30(2):1879-87. doi: 10.1007/s00520-021-06561-7. Sebastià C Páez-Carpio A Guillen E Paño B Arnaiz JA De Francisco AL et al Oral hydration as a safe prophylactic measure to prevent post-contrast acute kidney injury in oncologic patients with chronic kidney disease (IIIb) referred for contrast-enhanced computed tomography: subanalysis of the oncological group of the NICIR study Support Care Cancer 2022 02 30 2 1879 1887 10.1007/s00520-021-06561-7

Minieditorial referente ao artigo: Eficácia da Hidratação Oral na Prevenção da Nefropatia Induzida por Contraste em Indivíduos Submetidos a Intervenções Coronárias Eletivas

Short Editorial Oral Hydration May Be an Option to Prevent Contrast-Induced Nephropathy in Elective Coronary Interventions 0000-0001-9631-946X Evora Paulo Roberto Barbosa 1 Brasil Universidade de São Paulo – Faculdade de Medicina de Ribeirão Preto – Cirurgia e Anatomia, Ribeirão Preto, SP – Brasil Mailng Address: Paulo Roberto Barbosa Evora • Avenida Bandeirantes, 3900, Postal Code 14049-900, Ribeirão Preto, SP – Brazil E-mail: prbevora@gmail.com Fluid Therapy/methods Nephropathies/prevention and control Oral Hidratation Intravenous Hidratation Nicorandil/therapeutic use Cardiac Catheterization/methods

The study1 has a questionable ABC Cardio editorial profile and does not present any novelty. However, its publication decision would be useful for cardiologists in their preoperative control activity. Acute renal insufficiency is always discussed, and sometimes people say it is underestimated or overestimated.

Many studies support alternative protocols to prevent contrast-induced nephropathy (CIN) caused by iodine contrasts. It is opportune mentioning the safety of ambulatory protocols for vessels and heart exams carried out on the ambulatory “cath-lab.”

These protocols include 1) Drugs, 2) alkalinization with sodium bicarbonate, and; 3) hydration. Among different drugs, nicorandil has been used in patients with chronic renal dysfunction. A trial to assess its preventive effect on high-risk patients revealed substantial efficacy over hydration protocol for cardiac catheterization.2 , 3 Among different drugs, nicorandil has been used in patients with chronic renal dysfunction.4 , 5

We agree with the authors1 that the most effective preventive measure to date is intravenous hydration (IVH). However, current evidence shows that oral hydration (OH) is comparable to intravenous infusion. Nevertheless, the effectiveness of ambulatory OH still needs more investigations in elective coronary procedures.

The OH protocol performed by the patient appears to be like the hospital IVH protocol in renal protection. The authors suggest testing it in large trials in an attempt to prove that OH is effective and would be useful in medical practice.

Short Editorial related to the article: Effectiveness of Oral Hydration in Preventing Contrast-Induced Nephropathy in Individuals Undergoing Elective Coronary Interventions