title: 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.
abstract: 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.
authors.affiliation: Shiraz Nephro-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Maryam
authors.initials: M
authors.lastname: Pakfetrat
authors.forename: Mohammad Hossein
authors.initials: MH
authors.lastname: Nikoo
authors.forename: Leila
authors.initials: L
authors.lastname: Malekmakan
authors.forename: Mahmood
authors.initials: M
authors.lastname: Tabandeh
authors.forename: Jamshid
authors.initials: J
authors.lastname: Roozbeh
authors.forename: Mahshid Hashemi
authors.initials: MH
authors.lastname: Nasab
authors.forename: Mohammad Ali
authors.initials: MA
authors.lastname: Ostovan
authors.forename: Soheila
authors.initials: S
authors.lastname: Salari
authors.forename: Mohammad
authors.initials: M
authors.lastname: Kafi
authors.forename: Najmeh Moin
authors.initials: NM
authors.lastname: Vaziri
authors.forename: Farzad
authors.initials: F
authors.lastname: Adl
authors.forename: Mehdi
authors.initials: M
authors.lastname: Hosseini
authors.forename: Parviz
authors.initials: P
authors.lastname: Khajehdehi
mesh_terms: 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*
chemical_list: D002257:Carbonic Anhydrase Inhibitors; D003287:Contrast Media; D012965:Sodium Chloride; D017693:Sodium Bicarbonate; D000086:Acetazolamide