title: Sodium bicarbonate versus isotonic saline for the prevention of contrast-induced nephropathy in patients with diabetes mellitus undergoing coronary angiography and/or intervention: a multicenter prospective randomized study.
abstract: BACKGROUND
  Contrast-induced nephropathy (CIN) is a leading cause of acute renal failure and affects mortality and morbidity. Although the incidence of CIN is quite low in the general population, CIN incidence is significantly increased in patients with diabetes mellitus (DM).
  
  
  OBJECTIVE
  We compared the efficacy of prophylactic use consisting of a saline infusion or a sodium bicarbonate infusion for the prevention of CIN in patients with DM.
  
  
  METHODS
  A total of 195 DM patients who had unselected renal function were randomized into 2 groups: 101 patients were assigned to saline infusion, and 94 patients were assigned to bicarbonate infusion. The primary end point was the maximum increase in the serum creatinine (SCr) level, whereas the secondary end point was the development of CIN after the procedure.
  
  
  RESULTS
  The maximum increase in SCr levels was significantly lower in the saline group than in the bicarbonate group: -0.03 mg/dL (IQR, -0.09 to 0.10 mg/dL) versus 0.02 mg/dL (IQR, -0.09 to 0.13 mg/dL) (P = 0.014). The rate of CIN was significantly lower in the saline group than in the bicarbonate group (5.9% vs 16%, P = 0.024). In the subset of study participants with a baseline creatinine clearance of less than 60 mL/min, the maximum increase in SCr levels was significantly lower, -0.08 mg/dL (IQR, -0.13 to -0.04 mg/dL), in the saline group than in the bicarbonate group, 0.03 mg/dL (IQR, -0.13 to 0.12 mg/dL) (P = 0.004).
  
  
  CONCLUSIONS
  The use of prophylactic hydration with isotonic saline before coronary procedures may decrease SCr levels and reduce the incidence of CIN in patients with DM with unselected renal functions to a greater extent than sodium bicarbonate can.
authors.affiliation: Medical Faculty, Cardiology Department, Gaziosmanpasa University, Tokat/Turkey.
authors.forename: Fatih
authors.initials: F
authors.lastname: Koc
authors.forename: Kurtulus
authors.initials: K
authors.lastname: Ozdemir
authors.forename: Fatih
authors.initials: F
authors.lastname: Altunkas
authors.forename: Atac
authors.initials: A
authors.lastname: Celik
authors.forename: Orhan
authors.initials: O
authors.lastname: Dogdu
authors.forename: Metin
authors.initials: M
authors.lastname: Karayakali
authors.forename: Enes Elvin
authors.initials: EE
authors.lastname: Gul
authors.forename: Unal
authors.initials: U
authors.lastname: Erkorkmaz
authors.forename: Hasan
authors.initials: H
authors.lastname: Kadi
authors.forename: Mahmut
authors.initials: M
authors.lastname: Akpek
authors.forename: Mehmet Gungor
authors.initials: MG
authors.lastname: Kaya
mesh_terms: D003287:Contrast Media / Q000008:administration & dosage / Q000009:adverse effects*; D017023:Coronary Angiography; D003404:Creatinine / Q000097:blood; D003920:Diabetes Mellitus / Q000097:blood / Q000000981:diagnostic imaging* / Q000652:urine; D023381:Endpoint Determination; D005260:Female; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007552:Isotonic Solutions / Q000008:administration & dosage / Q000494:pharmacology*; D007674:Kidney Diseases / Q000097:blood / Q000139:chemically induced* / Q000150:complications / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D017693:Sodium Bicarbonate / Q000008:administration & dosage / Q000494:pharmacology*; D012965:Sodium Chloride / Q000008:administration & dosage / Q000494:pharmacology*
chemical_list: D003287:Contrast Media; D007552:Isotonic Solutions; D012965:Sodium Chloride; D017693:Sodium Bicarbonate; D003404:Creatinine