Publications by authors named "Nico J Aarts"

3 Publications

  • Page 1 of 1

A randomized comparison of 1-h sodium bicarbonate hydration versus standard peri-procedural saline hydration in patients with chronic kidney disease undergoing intravenous contrast-enhanced computerized tomography.

Nephrol Dial Transplant 2014 May 27;29(5):1029-36. Epub 2014 Feb 27.

Department of Thrombosis and Haemostasis, Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, The Netherlands.

Background: Guidelines recommend saline hydration for prophylaxis of contrast-induced acute kidney injury (CI-AKI) in patients with chronic kidney disease (CKD) undergoing intravenous contrast media-enhanced CT (CE-CT). The safety and efficacy of a brief hydration protocol using sodium bicarbonate in this population is unknown. We analysed whether 1-h sodium bicarbonate hydration prior to CE-CT is non-inferior to saline hydration prior to and after CE-CT in CKD patients.

Methods: We performed an open-label multicentre randomized trial. Patients were randomized to 250 mL of 1.4% sodium bicarbonate hydration prior to CE-CT or 1000 mL of 0.9% saline hydration prior to and, once again, after CE-CT. Primary outcome was the relative increase in serum creatinine 48-96 h post-CE-CT. Secondary outcomes were incidence of CI-AKI [serum creatinine increase >25%/>44 µmol/L (0.5 mg/dL)], recovery of renal function, the need for dialysis and 2-month hospital costs.

Results: Five hundred and seventy adult CKD patients undergoing CE-CT were randomized between 2010 and 2012, of whom 548 were included in the intention-to-treat population. Mean relative serum creatinine increase was 1.2% for sodium bicarbonate and 1.5% for saline (mean difference -0.3%; 95% confidence interval -2.7 to 2.1, P-value for non-inferiority <0.0001). CI-AKI occurred in 22 patients (4.1%); 8 (3.0%) randomized to sodium bicarbonate versus 14 (5.1%) to saline (P = 0.23). Renal function recovered in 75 and 69% of CI-AKI patients, respectively (P = 0.81). No patients developed a need for dialysis. Mean hydration costs per patient were €224 for the sodium bicarbonate and €683 for the saline regime (P < 0.001). Other healthcare costs were similar.

Conclusions: Short hydration with sodium bicarbonate prior to CE-CT was non-inferior to peri-procedural saline hydration with respect to renal safety and may result in healthcare savings. [Netherlands Trial Register (, Nr 2149, date of registration 23 December 2009.].
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May 2014

[Recognition of a tarsal coalition; clinical and radiological pointers].

Ned Tijdschr Geneeskd 2009 ;153:A616

Bronovo Ziekenhuis, Den Haag, The Netherlands.

A 34-year-old female had been suffering from pain in her left ankle for more than 6 years. Physical examination revealed no abnormalities other than a rigid subtalar joint. Using a CT scan and an MRI scan the diagnosis tarsal coalition was established. This condition is a fairly frequent cause of ankle pain, with a prevalence of 1-2%. However, it is easily missed by treating physicians. In this article the clinical and radiological pointers for establishing the diagnosis are described, and information about the treatment of tarsal coalitions is provided.
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February 2010

Intussusception in adults: report of four cases and review of the literature.

Case Rep Gastroenterol 2007 Aug 20;1(1):59-64. Epub 2007 Aug 20.

Department of Surgery, Bronovo Hospital, The Hague, The Netherlands.

Intussusception in adults is a rare clinical entity. The individual surgeon will not often encounter this condition. A lead-point for adult intussusception exists in 90% of cases and is frequently malignant. We present four cases and discuss treatment and diagnostic modalities. A comprehensive review of the literature is given. All cases were treated by resection according to oncologic principles without previous reduction. Histological examination showed non-Hodgkin lymphoma, lipoma, clear cell sarcoma and adenocarcinoma as the lead-points.
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August 2007