{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T18:18:17Z","timestamp":1783621097774,"version":"3.55.0"},"reference-count":47,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T00:00:00Z","timestamp":1783555200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"The Air Force Hospital of Northern Theater PLA,","award":["2025020"],"award-info":[{"award-number":["2025020"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Contrast-associated acute kidney injury (CA-AKI, historically termed contrast-induced nephropathy, CIN) is a leading cause of iatrogenic acute kidney injury (AKI) following iodinated contrast administration; yet the optimal preventive strategy remains controversial, especially in mild-to-moderate-risk patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This single-center retrospective observational study was conducted in strict accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. We consecutively screened adult patients undergoing contrast-enhanced computed tomography (CT) or angiography at a tertiary hospital in China between June 2022 and January 2025. After propensity score matching (PSM), 240 adult patients were included in the final analysis, allocated 1:1:1 into three groups: conventional hydration alone (control), hydration plus N-acetylcysteine (NAC), and hydration plus sodium bicarbonate. 1:1:1 nearest-neighbor PSM was performed to minimize confounding bias, with a caliper of 0.05. The primary endpoint was the incidence of CA-AKI within 72 hours after contrast exposure, defined per the 2024 European Society of Urogenital Radiology (ESUR) guidelines. Secondary endpoints included dynamic changes in renal function, renal replacement therapy (RRT) requirement, hospital stay duration, adverse events, and subgroup analyses by comorbidities and contrast modalities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>After PSM, 240 patients (80 per group) were included in the final analysis, with well-balanced baseline characteristics across groups (all standardized mean differences &lt;0.1, all P\u2009&gt;\u20090.05). The overall incidence of CA-AKI was 15.00% in the control group, 2.50% in the NAC group, and 7.50% in the sodium bicarbonate group. Hydration plus NAC significantly reduced CA-AKI risk compared with hydration alone (RR\u2009=\u20090.17, 95% CI: 0.04\u20130.74, Bonferroni-adjusted P\u2009=\u20090.004). Sodium bicarbonate showed a numerically lower CA-AKI incidence than control, but the difference did not reach statistical significance after correction (RR\u2009=\u20090.50, 95% CI: 0.19\u20131.31, adjusted P\u2009=\u20090.121). Repeated-measures ANOVA revealed significant group, time, and group\u2009\u00d7\u2009time interaction effects on serum creatinine (Scr), blood urea nitrogen (BUN), and estimated glomerular filtration rate (eGFR) (all P\u2009&lt;\u20090.001), with the mildest renal function fluctuations in the NAC group. The renoprotective efficacy of NAC was consistent across contrast-enhanced CT and angiography modalities. Advanced age, comorbid diabetes, comorbid hypertension, higher baseline Scr, and lower baseline eGFR were independent risk factors for CA-AKI [5,6,28] (all P\u2009&lt;\u20090.05). No patients required RRT in any group, with no significant difference in hospital stay duration or mild adverse event incidence across groups (all P\u2009&gt;\u20090.05).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>For patients with eGFR\u2009\u2265\u200930 mL\u00b7min\u2009\u207b\u2009\u00b9\u00b7(1.73 m\u00b2\u2009\u207b\u2009\u00b9), hydration combined with high-dose intravenous NAC significantly reduces the short-term incidence of CA-AKI compared with hydration alone, with a favorable safety profile and consistent efficacy across contrast modalities. Hydration plus sodium bicarbonate is a safe alternative for patients intolerant to NAC. These findings are hypothesis-generating and require verification in large-sample, multicenter prospective trials.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0353461","type":"journal-article","created":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T17:35:21Z","timestamp":1783618521000},"page":"e0353461","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Sodium Bicarbonate versus N-Acetylcysteine plus hydration versus hydration alone for preventing contrast-associated acute kidney injury: A single-center retrospective analysis with propensity score matching"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-0215-2014","authenticated-orcid":true,"given":"Ying-Huan","family":"Ma","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7021-9310","authenticated-orcid":true,"given":"Wei","family":"Wei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7340-6958","authenticated-orcid":true,"given":"Nan","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2838-1824","authenticated-orcid":true,"given":"Yan","family":"Sun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiao-Xu","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiu-Ying","family":"Hao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ai-Guo","family":"Xie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,7,9]]},"reference":[{"issue":"6","key":"pone.0353461.ref001","first-page":"3891","article-title":"Updated ESUR guidelines on contrast-associated acute kidney injury","volume":"34","author":"HS Thomsen","year":"2024","journal-title":"Eur Radiol"},{"issue":"8","key":"pone.0353461.ref002","first-page":"987","article-title":"Long-term kidney outcomes after contrast-associated acute kidney injury","volume":"184","author":"CR Parikh","year":"2024","journal-title":"JAMA Intern Med"},{"issue":"2","key":"pone.0353461.ref003","first-page":"105","article-title":"High-risk populations for contrast-associated acute kidney injury","volume":"20","author":"M Haase","year":"2024","journal-title":"Nat Rev Nephrol"},{"issue":"3","key":"pone.0353461.ref004","first-page":"451","article-title":"Contrast-induced acute kidney injury: Epidemiology and risk stratification","volume":"82","author":"MH Rosner","year":"2023","journal-title":"Am J Kidney Dis"},{"issue":"5","key":"pone.0353461.ref005","first-page":"989","article-title":"Epidemiology, diagnosis, and outcomes of acute kidney injury in critical illness","volume":"18","author":"SM Bagshaw","year":"2023","journal-title":"Clin J Am Soc Nephrol"},{"issue":"10","key":"pone.0353461.ref006","first-page":"821","article-title":"Hydration strategies for prevention of contrast-associated acute kidney injury","volume":"183","author":"SD Weisbord","year":"2023","journal-title":"JAMA Intern Med"},{"issue":"12","key":"pone.0353461.ref007","first-page":"1012","article-title":"Clinical relevance of prevention strategies for contrast-induced acute kidney injury","volume":"18","author":"N Lameire","year":"2023","journal-title":"Lancet Nephrol"},{"issue":"3","key":"pone.0353461.ref008","first-page":"170","article-title":"Pathophysiology of contrast-induced acute kidney injury","volume":"131","author":"SN Heyman","year":"2015","journal-title":"Nephron"},{"issue":"8","key":"pone.0353461.ref009","first-page":"489","article-title":"Oxidative stress in contrast-induced acute kidney injury: Therapeutic opportunities","volume":"19","author":"M 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Singh","year":"2021","journal-title":"Clin Nephrol"},{"issue":"6","key":"pone.0353461.ref014","first-page":"3881","article-title":"European Society of Urogenital Radiology ESUR. Guidelines on contrast media 2024","volume":"34","year":"2024","journal-title":"Eur Radiol"},{"issue":"1","key":"pone.0353461.ref015","first-page":"112","article-title":"Sodium bicarbonate for prevention of contrast-induced acute kidney injury","volume":"9","author":"MC Brunier","year":"2014","journal-title":"Clin J Am Soc Nephrol"},{"issue":"3","key":"pone.0353461.ref016","first-page":"564","article-title":"Urine alkalization with sodium bicarbonate for contrast-induced acute kidney injury: A meta-analysis of individual patient data","volume":"102","author":"H Zhang","year":"2022","journal-title":"Kidney Int"},{"issue":"15","key":"pone.0353461.ref017","first-page":"1400","article-title":"Sodium bicarbonate or N-acetylcysteine for prevention of contrast-induced acute kidney injury","volume":"378","author":"PRESERVE Trial Investigators","year":"2018","journal-title":"N Engl J Med"},{"issue":"12","key":"pone.0353461.ref018","first-page":"1869","article-title":"Re-evaluating the PRESERVE 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Chen","year":"2023","journal-title":"JAMA Intern Med"},{"issue":"12","key":"pone.0353461.ref022","first-page":"3215","article-title":"High-dose intravenous N-acetylcysteine versus oral NAC for preventing contrast-associated acute kidney injury in high-risk Chinese patients: A randomized controlled trial","volume":"6","author":"J Liu","year":"2021","journal-title":"Kidney Int Rep"},{"issue":"1","key":"pone.0353461.ref023","first-page":"123","article-title":"Contrast medium dosage and the risk of contrast-induced acute kidney injury: A dose-response meta-analysis","volume":"21","author":"M Li","year":"2023","journal-title":"BMC Med"},{"issue":"1","key":"pone.0353461.ref024","first-page":"412","article-title":"Epidemiology of contrast-associated acute kidney injury in Chinese patients with mild to moderate chronic kidney disease undergoing contrast-enhanced CT","volume":"23","author":"L Zou","year":"2022","journal-title":"BMC 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its renoprotective effect against contrast-associated acute kidney injury: A meta-analysis of randomized controlled trials","volume":"80","author":"Q Wang","year":"2022","journal-title":"Am J Kidney Dis"},{"issue":"5","key":"pone.0353461.ref033","first-page":"389","article-title":"Impact of contrast modality on contrast-induced acute kidney injury risk: Coronary angiography vs contrast-enhanced CT","volume":"24","author":"JS Kim","year":"2023","journal-title":"Cardiovasc Revasc Med"},{"issue":"2","key":"pone.0353461.ref034","first-page":"101","article-title":"Novel biomarkers for early detection of contrast-induced acute kidney injury: A systematic review","volume":"60","author":"L Yang","year":"2023","journal-title":"Crit Rev Clin Lab Sci"},{"key":"pone.0353461.ref035","article-title":"NKF-KDOQI clinical practice guideline for cardiovascular disease in CKD","volume":"82","author":"National Kidney Foundation","year":"2023","journal-title":"Am J Kidney 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kidney injury prophylaxis","volume":"26","author":"Y Zheng","year":"2023","journal-title":"Value Health"},{"issue":"6","key":"pone.0353461.ref044","first-page":"733","article-title":"Contrast-induced acute kidney injury: Update on prevention strategies","volume":"29","author":"LM Davis","year":"2023","journal-title":"Curr Opin Crit Care"},{"issue":"4","key":"pone.0353461.ref045","first-page":"729","article-title":"Contrast-induced acute kidney injury: Evolving concepts and preventive strategies","volume":"101","author":"MH Rosner","year":"2022","journal-title":"Kidney Int"},{"issue":"1","key":"pone.0353461.ref046","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1056\/NEJMra1214243","article-title":"Acute kidney injury and chronic kidney disease as interconnected syndromes","volume":"371","author":"LS Chawla","year":"2014","journal-title":"N Engl J Med"},{"issue":"9","key":"pone.0353461.ref047","first-page":"1446","article-title":"Contrast-induced acute kidney injury: Update on 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