Sodium bicarbonate plus isotonic saline versus saline for prevention of contrast-induced nephropathy in patients undergoing coronary angiography: a randomized controlled trial.
BACKGROUND
There is controversy about the prophylactic measures proposed for the prevention of contrast-induced nephropathy (CIN). We aim to compare the efficacy of the combination of sodium bicarbonate and isotonic saline and that of isotonic saline alone in preventing CIN.


METHODS
Randomized double-blind controlled trial.


METHODS
265 consecutive patients 18 years or older with a serum creatinine level of 1.5 mg/dL or greater undergoing elective coronary angiography from August 2007 to June 2008 in Tehran Heart Center, Tehran, Iran.


METHODS
Study participants were randomly assigned to receive either 75 mL of 8.4% sodium bicarbonate added to 1 L of isotonic saline (n = 135) or isotonic saline alone (n = 130) as a bolus of 3 mL/kg for 1 hour before contrast injection, followed by an infusion of 1 mL/kg/h for 6 hours after the procedure.


METHODS
The primary end point was an absolute (>or=0.5 mg/dL) or relative (>or=25%) increase in serum creatinine level 48 hours after the procedure (CIN).


RESULTS
There were no significant differences between the bicarbonate and saline groups regarding baseline demographic and biochemical characteristics, including baseline serum creatinine level (1.63 +/- 0.32 [SD] versus 1.66 +/- 0.50 mg/dL), baseline glomerular filtration rate (46.4 +/- 12 versus 45.4 +/- 12 mL/min/1.73 m(2)), and baseline urine pH (5.42 +/- 0.6 versus 5.46 +/- 0.8). Nine patients (7.4%) receiving sodium bicarbonate developed CIN as opposed to 7 patients (5.9%) in the saline group, which was not statistically different (odds ratio, 1.26; 95% confidence interval, 0.45 to 3.50; P = 0.6).


CONCLUSIONS
The trial did not follow up participants to assess need for dialysis and mortality rate.


CONCLUSIONS
The combination therapy of sodium bicarbonate plus saline does not offer additional benefits over hydration with saline alone in the prevention of CIN.
Vasheghani-Farahani
Ali
A
Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
Sadigh
Gelareh
G
Kassaian
Seyed Ebrahim
SE
Khatami
Seyed Mohammad Reza
SM
Fotouhi
Akbar
A
Razavi
Seyed Amir Hossein
SA
Mansournia
Mohammad Ali
MA
Yamini-Sharif
Ahmad
A
Amirzadegan
Alireza
A
Salarifar
Mojtaba
M
Sadeghian
Saeed
S
Davoodi
Gholamreza
G
Borumand
Mohammad Ali
MA
Esfehani
Farah Aiatollahzade
FA
Darabian
Sirous
S
D058186:Acute Kidney Injury / Q000097:blood / Q000139:chemically induced* / Q000503:physiopathology / Q000517:prevention & control*; D000368:Aged; D015415:Biomarkers / Q000097:blood; D003287:Contrast Media / Q000008:administration & dosage / Q000009:adverse effects*; D017023:Coronary Angiography / Q000379:methods; D003404:Creatinine / Q000097:blood; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D007262:Infusions, Intravenous; D007275:Injections, Intravenous; D007472:Iohexol / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D017693:Sodium Bicarbonate / Q000008:administration & dosage*; D012965:Sodium Chloride / Q000008:administration & dosage*; D013997:Time Factors; D016896:Treatment Outcome; D014283:Triiodobenzoic Acids / Q000009:adverse effects
D015415:Biomarkers; D003287:Contrast Media; D014283:Triiodobenzoic Acids; D007472:Iohexol; D012965:Sodium Chloride; D017693:Sodium Bicarbonate; D003404:Creatinine; C044834:iodixanol