Prevention of contrast-induced nephropathy with Na/K citrate.
OBJECTIVE
Contrast-induced nephropathy (CIN) is a frequent complication of many radiological procedures involving the application of contrast media. It represents a significant health problem that causes the increase in mortality, morbidity, and medical costs. For the prevention of CIN, a number of methods have been proposed to be effective. Among them, alkalinization of urine takes an important place. Although the Na/K citrate is a well-known agent for urine alkalinization, it has not been studied in the prevention of CIN.


RESULTS
Two hundred and two patients who underwent coronary angiography were included in the study. They were randomized into groups receiving the drug Na/K citrate per os and to the control group. Serum creatinine and glomerular filtration rate were determined in all patients immediately before coronary angiography, and 48 h after the procedure. CIN criteria were a creatinine increase of >25%, reduction in the glomerular filtration rate by >25%, or an increase in serum creatinine of >44 μmol/L. The incidence of CIN in the group receiving Na/K citrate was significantly lower when compared with the control group (4% compared with 20%, P = 0.0001). Patients who had a urine pH <6 had a more than ten-fold higher incidence of contrast nephropathy compared with patients whose urine pH was >6.


CONCLUSIONS
Alkalinization of urine using the Na/K citrate may reduce the incidence of CIN.
Department of Cardiology, University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina.
Darko
D
Markota
Ivica
I
Markota
Boris
B
Starcevic
Monika
M
Tomic
Zrinko
Z
Prskalo
Ivica
I
Brizic
D002951:Citrates / Q000627:therapeutic use*; D003287:Contrast Media / Q000009:adverse effects*; D017023:Coronary Angiography / Q000009:adverse effects; D003404:Creatinine / Q000378:metabolism; D004232:Diuretics / Q000627:therapeutic use*; D004338:Drug Combinations; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007674:Kidney Diseases / Q000139:chemically induced / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D019357:Potassium Citrate / Q000627:therapeutic use*; D000077559:Sodium Citrate
D002951:Citrates; D003287:Contrast Media; D004232:Diuretics; D004338:Drug Combinations; D000077559:Sodium Citrate; D003404:Creatinine; D019357:Potassium Citrate
Alkalinization; Citrate; Contrast-induced nephropathy; Urine