title: A new protocol using sodium bicarbonate for the prevention of contrast-induced nephropathy in patients undergoing coronary angiography.
abstract: Contrast-induced nephropathy (CIN) is associated with increased morbidity and mortality rates. Although a previous study reported that pretreatment with sodium bicarbonate is more effective than sodium chloride for prophylaxis of CIN, this has not been a universal finding. We performed a prospective randomized trial to investigate whether CIN can be avoided using sodium bicarbonate. In total 155 patients with a glomerular filtration rate (GFR) <60 ml/min/1.73 m(2) who were undergoing coronary angiography were enrolled. We assigned patients to sodium chloride plus sodium bicarbonate (bicarbonate group, n = 78) or sodium chloride alone (chloride group, n = 77). Infusion of sodium bicarbonate at 1 ml/kg/hour continued from 3 hours before to 6 hours after coronary angiography. CIN was defined as a 25% increase in serum creatinine from baseline value or an absolute increase of ≥0.5 mg/dl, which appeared within 2 days of contrast. Baseline GFR was not significantly different between the 2 groups. Patients in the bicarbonate group had a higher GFR than those in the chloride group on day 2 (45.8 ± 13.4 vs 40.9 ± 14.6 ml/min/1.73 m(2), p = 0.031) and at 1 month (49.5 ± 14.7 vs 43.7 ± 15.5 ml/min/1.73 m(2), p = 0.019). CIN occurred in 10 patients (13%) in the chloride group but in only 2 patients (2.6%) in the bicarbonate group (p = 0.012). Sodium chloride plus sodium bicarbonate is more effective than sodium chloride alone for prophylaxis of CIN and can lead to retention of better long-term renal function.
authors.affiliation: Department of Cardiology, Kyoto Kujo Hospital, Kyoto, Japan. m3uk-motohiro@kujohp.or.jp
authors.forename: Masayuki
authors.initials: M
authors.lastname: Motohiro
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kamihata
authors.forename: Satoshi
authors.initials: S
authors.lastname: Tsujimoto
authors.forename: Takeshi
authors.initials: T
authors.lastname: Seno
authors.forename: Kenichi
authors.initials: K
authors.lastname: Manabe
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Isono
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Sutani
authors.forename: Fumio
authors.initials: F
authors.lastname: Yuasa
authors.forename: Toshiji
authors.initials: T
authors.lastname: Iwasaka
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media / Q000009:adverse effects*; D017023:Coronary Angiography; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000139:chemically induced* / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D017693:Sodium Bicarbonate / Q000494:pharmacology*; D012965:Sodium Chloride / Q000494:pharmacology
chemical_list: D003287:Contrast Media; D012965:Sodium Chloride; D017693:Sodium Bicarbonate