title: Sodium chloride vs. sodium bicarbonate for the prevention of contrast medium-induced nephropathy: a randomized controlled trial.
abstract: OBJECTIVE
  The most effective regimen for the prevention of contrast-induced nephropathy (CIN) remains uncertain. Our purpose was to compare two regimens of sodium bicarbonate with 24 h sodium chloride 0.9% infusion in the prevention of CIN.
  
  
  RESULTS
  We performed a prospective, randomized trial between March 2005 and December 2009, including 258 consecutive patients with renal insufficiency undergoing intravascular contrast procedures. Patients were randomized to receive intravenous volume supplementation with either (A) sodium chloride 0.9% 1 mL/kg/h for at least 12h prior and after the procedure or (B) sodium bicarbonate (166 mEq/L) 3 mL/kg for 1 h before and 1 mL/kg/h for 6 h after the procedure or (C) sodium bicarbonate (166 mEq/L) 3 mL/kg over 20 min before the procedure plus sodium bicarbonate orally (500 mg per 10 kg). The primary endpoint was the change in estimated glomerular filtration rate (eGFR) within 48 h after contrast. Secondary endpoints included the development of CIN. The maximum change in eGFR was significantly greater in Group B compared with Group A {mean difference -3.9 [95% confidence interval (CI), -6.8 to -1] mL/min/1.73 m2, P = 0.009} and similar between groups C and B [mean difference 1.3 (95% CI, -1.7-4.3) mL/min/1.73 m(2), P = 0.39]. The incidence of CIN was significantly lower in Group A (1%) vs. Group B (9%, P = 0.02) and similar between Groups B and C (10%, P = 0.9).
  
  
  CONCLUSIONS
  Volume supplementation with 24 h sodium chloride 0.9% is superior to sodium bicarbonate for the prevention of CIN. A short-term regimen with sodium bicarbonate is non-inferior to a 7 h regimen. ClinicalTrials.gov Identifier: NCT00130598.
authors.affiliation: Department of Nephrology,  University Hospital Basel, Basel,  Switzerland.
authors.forename: Theresia
authors.initials: T
authors.lastname: Klima
authors.forename: Andreas
authors.initials: A
authors.lastname: Christ
authors.forename: Ivana
authors.initials: I
authors.lastname: Marana
authors.forename: Stefan
authors.initials: S
authors.lastname: Kalbermatter
authors.forename: Heiko
authors.initials: H
authors.lastname: Uthoff
authors.forename: Emanuel
authors.initials: E
authors.lastname: Burri
authors.forename: Sabine
authors.initials: S
authors.lastname: Hartwiger
authors.forename: Christian
authors.initials: C
authors.lastname: Schindler
authors.forename: Tobias
authors.initials: T
authors.lastname: Breidthardt
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Marenzi
authors.forename: Christian
authors.initials: C
authors.lastname: Mueller
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media / Q000009:adverse effects*; D005260:Female; D005919:Glomerular Filtration Rate / Q000187:drug effects; D006801:Humans; D007262:Infusions, Intravenous; D007674:Kidney Diseases / Q000503:physiopathology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012076:Renal Agents / Q000008:administration & dosage*; D017693:Sodium Bicarbonate / Q000008:administration & dosage*; D012965:Sodium Chloride / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media; D012076:Renal Agents; D012965:Sodium Chloride; D017693:Sodium Bicarbonate