Sodium bicarbonate versus sodium chloride and oral N-acetylcysteine for the prevention of contrast-induced nephropathy in advanced chronic kidney disease.
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.
Shavit
Linda
L
Nephrology Unit, Shaare Zedek Medical Center, Jerusalem, Israel. lshavit@szmc.org.il
Korenfeld
Roman
R
Lifschitz
Meyer
M
Butnaru
Ady
A
Slotki
Itzchak
I
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
D003287:Contrast Media; D016166:Free Radical Scavengers; D012965:Sodium Chloride; D017693:Sodium Bicarbonate; D003401:Creatine; D000111:Acetylcysteine