2018Nephrology5177 patients

PRESERVE

Therapy group: Renal protection · Therapy: Sodium bicarbonate and acetylcysteine

In high-risk patients undergoing angiography, neither intravenous bicarbonate versus saline nor oral acetylcysteine versus placebo prevented death, dialysis, or persistent kidney function decline.

Published in N Engl J Med (2018)

Question: Do intravenous sodium bicarbonate (instead of saline) and oral acetylcysteine reduce serious renal complications after angiography in high-risk patients?
Design: Randomized, double-blind, 2-by-2 factorial trial that assigned 5177 patients; the modified intention-to-treat analysis included 4993. The sponsor stopped it after a prespecified interim analysis.
Population: Patients at high risk for renal complications who were scheduled for angiography.
Intervention: Intravenous 1.26% sodium bicarbonate and/or oral acetylcysteine for 5 days.
Control: Intravenous 0.9% sodium chloride and/or oral placebo.
Primary outcome: Composite of death, need for dialysis, or a persistent increase of at least 50% from baseline in serum creatinine at 90 days.
Results: The primary endpoint occurred in 110 of 2511 patients (4.4%) with bicarbonate versus 116 of 2482 (4.7%) with sodium chloride (OR 0.93; 95% CI 0.72 to 1.22; P=0.62), and in 114 of 2495 (4.6%) with acetylcysteine versus 112 of 2498 (4.5%) with placebo (OR 1.02; 95% CI 0.78 to 1.33; P=0.88). There was no interaction between the two interventions (P=0.33) and no significant differences in contrast-associated acute kidney injury.
Conclusion: Neither intravenous bicarbonate versus saline nor oral acetylcysteine versus placebo provided benefit in high-risk patients undergoing angiography.
Why it matters: The trial challenged the routine use of these two measures for preventing contrast nephropathy, which had been widely applied without definitive evidence.

Card generated automatically with AI from the abstract of the original publication and the trial registry; every figure was checked against those sources. It may contain errors: verify the data at the source before using it for clinical decisions.

Generated on October 15, 2026

Sources

Original publication on PubMed (PMID 29130810) ↗Outcomes after Angiography with Sodium Bicarbonate and Acetylcysteine.
Journal article (DOI) ↗
ClinicalTrials.gov record (NCT01467466) ↗

Videos explaining it

SCAI 2018: PRESERVE Trial

SCAI · SCAI-TV ↗4:57Video page

Source: SCAI-TV · YouTube
Date: 27 Apr 2018
Audio: English
Subtitles: MultilingualYouTube
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