Preventing Contrast-induced Nephropathy: Evaluating Hydration Strategies and L-carnitine Administration

Preventing Nephropathy Induced by Iodinated Contrast Media in Patients With Renal Impairment: a Randomized Trial Evaluating the Effectiveness of Two Hydration Strategies and L-carnitine Administration

The general objective of this open, pilot study is to characterize biological parameters related to acute kidney injury among patients undergoing a programmed coronarography with injection of contrast material. The study focuses on two main factors that may influence acute kidney injury: (1) sodium chloride hydration strategy versus sodium bicarbonate hydration strategy and (2) presence of oral L-carnitine treatment versus absence of oral L-carnitine treatment. We will also test for a potential interaction between these two factors.

Inclusion Criteria:

• The patient must have given his/her informed and signed consent
• The patient must be insured or beneficiary of a health insurance plan
• The patient is scheduled for a coronarography
• The patient can come back to the hospital on days 2 and 7 after the coronarography for follow up
• The patient has moderate to severe renal insufficiency (glomerular filtration rate < 60 ml / min / 1.73 m^2)
• The patient has not had any oral antidiabetic treatments, or diuretic treatments, within 48 hours preceding the coronarography
• Lack of treatment with ACE inhibitors or ARA2 24 hours prior to coronary

Exclusion Criteria:

• The patient is participating in another study
• The patient is in an exclusion period determined by another study
• The patient is under judicial protection
• The patient is under any kind of guardianship
• The patient refuses to sign the consent form
• It is impossible to correctly inform the patient
• The patient is unable to participate in follow-up visits at days 2 and 7 after the coronarography
• The patient is pregnant or breastfeeding
• The patient is taking L-carnitine
• The patient has a contra indication for a treatment used in this study
• Acute heart failure
• Infarction, acute phase
• Hemodialysis patient
• Myeloma
• Epileptic patient treated with Depakine (valproic acid) (carnitine can lower epilepsy-related thresholds by speeding up the metabolism of Depakine)