title: Prevention of contrast-induced nephropathy by bolus injection of sodium bicarbonate in patients with chronic kidney disease undergoing emergent coronary procedures.
abstract: We conducted a prospective study to determine whether a bolus injection of sodium bicarbonate before emergent coronary procedures in patients with chronic kidney disease (CKD) might prevent contrast-induced nephropathy (CIN). We enrolled 59 patients with CKD, defined by a serum creatinine concentration of >1.1 mg/dl or an estimated glomerular filtration rate of <60 ml/min, who were scheduled at admission to undergo an emergent coronary procedure. The patients were randomized to receive a bolus intravenous injection of 154 mEq/L of sodium bicarbonate (n = 30) or sodium chloride (n = 29) at the dose of 0.5 ml/kg, before contrast administration, followed by infusion of 154 mEq/L sodium bicarbonate at 1 ml/kg/hour for 6 hours in both groups. The primary end point was the occurrence of CIN, defined as an increase by > 25% or > 0.5 mg/dl of the serum creatinine level within 2 days after the procedure. In the sodium bicarbonate group, the serum creatinine concentration remained unchanged within 2 days of contrast administration (from 1.32 ± 0.46 to 1.38 ± 0.60 mg/dl, p = 0.33). In contrast, it had increased in the sodium chloride group (1.51 ± 0.59 to 1.91 ± 1.19 mg/dl, p = 0.006). The incidence of CIN was significantly lower in the sodium bicarbonate group than in the sodium chloride group (3.3% vs 27.6%, p = 0.01). In conclusion, rapid alkalization by bolus injection of sodium bicarbonate was effective for the prevention of CIN in patients with CKD undergoing emergent procedures.
authors.affiliation: Division of Cardiology, Osaka General Medical Center, Osaka, Japan. u_hiromichi@yahoo.co.jp
authors.forename: Hiromichi
authors.initials: H
authors.lastname: Ueda
authors.forename: Takahisa
authors.initials: T
authors.lastname: Yamada
authors.forename: Masaharu
authors.initials: M
authors.lastname: Masuda
authors.forename: Yuji
authors.initials: Y
authors.lastname: Okuyama
authors.forename: Takashi
authors.initials: T
authors.lastname: Morita
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Furukawa
authors.forename: Tanaka
authors.initials: T
authors.lastname: Koji
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Iwasaki
authors.forename: Takeshi
authors.initials: T
authors.lastname: Okada
authors.forename: Masato
authors.initials: M
authors.lastname: Kawasaki
authors.forename: Yuki
authors.initials: Y
authors.lastname: Kuramoto
authors.forename: Takashi
authors.initials: T
authors.lastname: Naito
authors.forename: Tadao
authors.initials: T
authors.lastname: Fujimoto
authors.forename: Issei
authors.initials: I
authors.lastname: Komuro
authors.forename: Masatake
authors.initials: M
authors.lastname: Fukunami
mesh_terms: D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging / Q000628:therapy*; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D003287:Contrast Media / Q000009:adverse effects*; D017023:Coronary Angiography / Q000009:adverse effects* / Q000379:methods; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate / Q000187:drug effects; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D011446:Prospective Studies; D051437:Renal Insufficiency / Q000139:chemically induced / Q000517:prevention & control*; D017693:Sodium Bicarbonate / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media; D017693:Sodium Bicarbonate