title: Randomized Trial of Bicarbonate or Saline Study for the Prevention of Contrast-Induced Nephropathy in Patients with CKD.
abstract: OBJECTIVE
  Sodium bicarbonate has been proposed for protection of the kidney from contrast-induced AKI (CIAKI). However, the effects of bicarbonate on long-term important clinical outcomes are uncertain.
  
  
  METHODS
  In a prospective, double-blind, multicenter randomized clinical trial, 391 patients with an eGFR<45 ml/min per 1.73 m(2) undergoing elective coronary or peripheral angiography were randomized to an infusion with a high dose of isotonic sodium bicarbonate (target 2.0 mEq/kg) or a similar molar amount of isotonic sodium chloride. The primary outcome was a composite of mortality, dialysis, or a sustained 20% reduction in eGFR at 6 months.
  
  
  RESULTS
  There were 391 patients enrolled between March 2010 and May 2012. The incidence of the primary outcome was 14.9% in the bicarbonate group and 16.3% in the control group in the intention-to-treat population (P=0.78). There was also no difference in the incidence of CIAKI between the treatment groups (14.5% versus 12.1%, respectively; P=0.20). CIAKI was associated with a higher incidence of sustained loss of kidney function at 6 months compared with those without CIAKI (21.2% versus 7.7%, respectively; P=0.06).
  
  
  CONCLUSIONS
  High-dose sodium bicarbonate infusion in patients with eGFR<45 ml/min per 1.73 m(2) undergoing angiography did not demonstrate a difference in incidence of the composite of death, dialysis, or sustained 6-month reduction in eGFR or CIAKI compared with sodium chloride.
authors.affiliation: Department of Medicine, University of Vermont Medical Center, Burlington, Vermont; Richard.solomon@vtmednet.org.
authors.forename: Richard
authors.initials: R
authors.lastname: Solomon
authors.affiliation: Division of Cardiology, Miriam Hospital, Providence, Rhode Island;
authors.forename: Paul
authors.initials: P
authors.lastname: Gordon
authors.affiliation: Sarah Connon Research Institute, Hospital Corporation of America, Nashville, Tennessee;
authors.forename: Steven V
authors.initials: SV
authors.lastname: Manoukian
authors.affiliation: Division of Cardiology, Rhode Island Hospital, Providence, Rhode Island;
authors.forename: J Dawn
authors.initials: JD
authors.lastname: Abbott
authors.affiliation: Christ Hospital Heart and Vascular Center, Lindner Research Center, Cincinnati, Ohio;
authors.forename: Dean J
authors.initials: DJ
authors.lastname: Kereiakes
authors.affiliation: Division of Cardiology, Stony Brook University Hospital, Stony Brook, New York; and.
authors.forename: Allen
authors.initials: A
authors.lastname: Jeremias
authors.affiliation: Mount Sinai Hospital, New York City, New York.
authors.forename: Michael
authors.initials: M
authors.lastname: Kim
authors.affiliation: Department of Medicine, University of Vermont Medical Center, Burlington, Vermont;
authors.forename: Harold L
authors.initials: HL
authors.lastname: Dauerman
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced / Q000401:mortality / Q000503:physiopathology / Q000517:prevention & control*; D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media / Q000009:adverse effects*; D017023:Coronary Angiography; D004311:Double-Blind Method; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D057194:Intention to Treat Analysis; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000503:physiopathology; D017693:Sodium Bicarbonate / Q000008:administration & dosage*; D012965:Sodium Chloride / Q000008:administration & dosage
chemical_list: D003287:Contrast Media; D012965:Sodium Chloride; D017693:Sodium Bicarbonate
keywords: acute renal failure; coronary artery disease; dialysis; mortality