title: Sodium bicarbonate versus sodium chloride and oral N-acetylcysteine for the prevention of contrast-induced nephropathy in advanced chronic kidney disease.
abstract: BACKGROUND
  Contrast-induced acute kidney injury (CI-AKI) is one of the leading causes of hospital-acquired acute kidney injury. Multiple clinical studies have proposed several preventive strategies.
  
  
  OBJECTIVE
  To examine the efficacy of sodium bicarbonate compared with sodium chloride and oral N-acetylcysteine (NAC) for preventive hydration after cardiac catheterization.
  
  
  METHODS
  We conducted a prospective, single-center trial. Patients with chronic kidney disease (CKD) stage III-IV undergoing cardiac catheterization were allocated to receive either an infusion of 0.9% sodium chloride and oral NAC or 154 mEq/L sodium bicarbonate. MAIN: Outcome measure CI-AKI, defined as an increase of 25% or 0.3 mg/dL or more in plasma creatinine within 2 days of contrast administration.
  
  
  RESULTS
  Ninety-three patients were allocated to one of the two groups: 42 patients in the saline plus NAC group and 51 patients in the bicarbonate group. There were no statistically significant differences between the groups in the most important clinical and procedural characteristics. Baseline plasma creatinine levels, estimated glomerular filtration rate, incidence of diabetes mellitus, hypertension, congestive heart failure, and contrast medium volume were similar. Mean plasma creatinine concentration was 1.76 +/- 0.54 mg/dL in the saline and NAC group and 1.9 +/- 1 mg/dL in the bicarbonate group (P = 0.23). The rate of CI-AKI was 9.8% in the bicarbonate group and 8.4% in the saline plus NAC group. No patient required renal replacement therapy.
  
  
  CONCLUSIONS
  Hydration with sodium bicarbonate is not more effective than hydration with sodium chloride and oral NAC for prophylaxis of CI-AKI in patients with CKD stage III-IV undergoing cardiac catheterization.
authors.affiliation: Nephrology Unit, Shaare Zedek Medical Center, Jerusalem, Israel. lshavit@szmc.org.il
authors.forename: Linda
authors.initials: L
authors.lastname: Shavit
authors.forename: Roman
authors.initials: R
authors.lastname: Korenfeld
authors.forename: Meyer
authors.initials: M
authors.lastname: Lifschitz
authors.forename: Ady
authors.initials: A
authors.lastname: Butnaru
authors.forename: Itzchak
authors.initials: I
authors.lastname: Slotki
mesh_terms: D000111:Acetylcysteine / Q000627:therapeutic use*; D000368:Aged; D006328:Cardiac Catheterization / Q000009:adverse effects*; D003287:Contrast Media / Q000009:adverse effects*; D003401:Creatine / Q000097:blood / Q000187:drug effects; D003681:Dehydration / Q000517:prevention & control; D005260:Female; D016166:Free Radical Scavengers / Q000627:therapeutic use; D005919:Glomerular Filtration Rate; D006801:Humans; D007674:Kidney Diseases / Q000139:chemically induced / Q000517:prevention & control*; D007676:Kidney Failure, Chronic / Q000517:prevention & control; D008297:Male; D011446:Prospective Studies; D012044:Regression Analysis; D018570:Risk Assessment; D017693:Sodium Bicarbonate / Q000627:therapeutic use*; D012965:Sodium Chloride / Q000627:therapeutic use*; D013223:Statistics as Topic
chemical_list: D003287:Contrast Media; D016166:Free Radical Scavengers; D012965:Sodium Chloride; D017693:Sodium Bicarbonate; D003401:Creatine; D000111:Acetylcysteine