title: Prevention of contrast-induced nephropathy by use of bicarbonate solution: preliminary results and literature review.
abstract: BACKGROUND
  The incidence of contrast-induced nephropathy has increased simultaneously with the increase in contrast medium use in diagnostic and interventional procedures. The incidence of contrast-induced nephropathy in the general population is low, but increases exponentially in patients with risk factors, such as diabetes and chronic kidney disease. Several strategies have been used in order to prevent contrast-induced nephropathy. The most efficient strategies are saline hydration (0.9% or 0.45%), use of low-or iso-osmolality contrast medium, and sodium bicarbonate infusion.
  
  
  OBJECTIVE
  The aim of this study was to review the pertinent literature and to assess the efficacy of hydration with 1.3% sodium bicarbonate compared with hydration with 0.9% saline solution in preventing contrast-induced nephropathy in high-risk patients.
  
  
  METHODS
  A systematic search of the literature was conducted in PubMed by using the following keywords: bicarbonate, nephropathy, contrast medium, and acute kidney failure. In addition, 27 patients with diabetes and/or chronic kidney disease, diagnosed with some kind of cancer were randomized for study.
  
  
  RESULTS
  None of the patients developed contrast-induced nephropathy characterized as a 0.5 mg/ dL-increase and/or a relative 25%-increase in baseline creatinine.
  
  
  CONCLUSIONS
  The literature review strongly suggested that sodium bicarbonate is effective in preventing contrast-induced nephropathy. Regarding the randomized study, saline solution and bicarbonate solution had similar efficacy in preventing contrast-induced nephropathy. However, the small number of patients does not allow definite conclusions.
authors.affiliation: Fundação PIO XII of Barretos, city of Barretos, state of São Paulo, Brazil.
authors.forename: Ricardo Gonçalves da
authors.initials: RG
authors.lastname: Silva
authors.forename: Nelson Gonçalves da
authors.initials: NG
authors.lastname: Silva
authors.forename: Fabiano
authors.initials: F
authors.lastname: Lucchesi
authors.forename: Emmanuel A
authors.initials: EA
authors.lastname: Burdmann
mesh_terms: D000368:Aged; D003287:Contrast Media / Q000009:adverse effects*; D006801:Humans; D007674:Kidney Diseases / Q000139:chemically induced* / Q000517:prevention & control*; D017693:Sodium Bicarbonate / Q000627:therapeutic use*; D012965:Sodium Chloride / Q000627:therapeutic use*; D012996:Solutions
chemical_list: D003287:Contrast Media; D012996:Solutions; D012965:Sodium Chloride; D017693:Sodium Bicarbonate