A comparison of sodium bicarbonate infusion versus normal saline infusion and its combination with oral acetazolamide for prevention of contrast-induced nephropathy: a randomized, double-blind trial.
BACKGROUND
Contrast-induced nephropathy (CIN) is commonly encountered. Because the therapy of choice for prevention of CIN is controversial, in this study we compared the preventive efficacy of bicarbonate (Bi) infusion in dextrose water versus normal saline (NLS) infusion alone or in combination with oral acetazolamide (AZ).


METHODS
In a double-blind and randomized clinical trial, all patients undergoing coronary angiography or percutaneous coronary intervention received NLS (NLS group), its combination with AZ (AZ group) or infusion of Bi (Bi group) before the procedures. RIFLE (risk of renal failure, injury to the kidney, failure of kidney function, loss of kidney function, and end-stage renal disease) criteria were used to define CIN-associated acute kidney injury (AKI).


RESULTS
The risk of AKI in CIN was significantly lower in the Bi and AZ groups than in the NLS group (P <or= 0.04). Comparing pre-treatment and post-treatment values in each group the following results were obtained: serum creatinine (Scr) increased and eGFR decreased significantly in the NLS group (P = 0.04) and in all patients (P = 0.001, P = 0.02, respectively). In addition, serum potassium decreased significantly in the Bi and NLS groups (P <or= 0.02). Also, serum Bi increased significantly in the Bi group (P = 0.001) whereas it decreased significantly in the AZ group (P = 0.001). Urinary pH also increased in all groups (P <or= 0.04) except the NLS group (P > 0.05).


CONCLUSIONS
It seems that both Bi and AZ reduce the risk of CIN-related AKI, and close monitoring of serum potassium is needed during bicarbonate infusion.
Pakfetrat
Maryam
M
Shiraz Nephro-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
Nikoo
Mohammad Hossein
MH
Malekmakan
Leila
L
Tabandeh
Mahmood
M
Roozbeh
Jamshid
J
Nasab
Mahshid Hashemi
MH
Ostovan
Mohammad Ali
MA
Salari
Soheila
S
Kafi
Mohammad
M
Vaziri
Najmeh Moin
NM
Adl
Farzad
F
Hosseini
Mehdi
M
Khajehdehi
Parviz
P
D000086:Acetazolamide / Q000008:administration & dosage*; D000284:Administration, Oral; D002257:Carbonic Anhydrase Inhibitors / Q000008:administration & dosage*; D003287:Contrast Media / Q000009:adverse effects*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D007674:Kidney Diseases / Q000139:chemically induced*; D008297:Male; D008875:Middle Aged; D017693:Sodium Bicarbonate / Q000008:administration & dosage*; D012965:Sodium Chloride / Q000008:administration & dosage*
D002257:Carbonic Anhydrase Inhibitors; D003287:Contrast Media; D012965:Sodium Chloride; D017693:Sodium Bicarbonate; D000086:Acetazolamide