Sodium bicarbonate versus normal saline for protection against contrast nephropathy.
Contrast-induced nephropathy (CIN) is a form of acute kidney injury and a significant source of morbidity and mortality. We defined CIN as an increase in serum creatinine (SCr) of 25% or more within 48 hours of receiving contrast. We retrospectively compared sodium bicarbonate with normal saline for prevention of CIN. One hundred and eighty-seven patients exposed to contrast during cardiac angiography, treated prophylactically either with sodium bicarbonate (n = 89) or with normal saline (n = 98), were studied. Baseline characteristics of both groups were similar in terms of age, amount of contrast, presence of diabetes mellitus, and use of furosemide and angiotensin-converting enzyme inhibitor. Patients in bicarbonate group had more severe renal disease with higher baseline SCr (1.58 +/- 0.5 mg/dL vs. 1.28 +/- 0.3 mg/dL, p = 0.001) and lower estimated glomerular filtration rate (eGFR, 51.06 +/- 14.0 mL/min vs. 62.3+/-13.5 mL/min, p = 0.001) compared to the normal saline group. After the contrast exposure, there was significant drop in eGFR (6.4%) and increase in SCr (11.3%) in the normal saline group and no significant change in the bicarbonate group. Three patients (3.4%) in the bicarbonate group as opposed to 14 patients (14.3%) in the normal saline group developed CIN (p = 0.011). Two patients in the normal saline group and none in the bicarbonate group needed dialysis. There was no significant difference in serum creatinine at three-month follow-up in either group. The above findings suggest that hydration with intravenous sodium bicarbonate is more effective than normal saline in preventing contrast-induced nephropathy.
Budhiraja
Pooja
P
University of Arizona College of Medicine, Tucson, Arizona, USA.
Chen
Zhao
Z
Popovtzer
Mordecai
M
D000368:Aged; D006328:Cardiac Catheterization; D003287:Contrast Media / Q000009:adverse effects*; D017023:Coronary Angiography; D003404:Creatinine / Q000097:blood; D004573:Electrolytes / Q000097:blood; D005919:Glomerular Filtration Rate; D006801:Humans; D007472:Iohexol / Q000009:adverse effects / Q000031:analogs & derivatives*; D007674:Kidney Diseases / Q000139:chemically induced / Q000517:prevention & control* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012189:Retrospective Studies; D017693:Sodium Bicarbonate / Q000627:therapeutic use*; D012965:Sodium Chloride / Q000627:therapeutic use*
D003287:Contrast Media; D004573:Electrolytes; D007472:Iohexol; D012965:Sodium Chloride; C038192:iopromide; D017693:Sodium Bicarbonate; D003404:Creatinine