title: Sodium Bicarbonate Prevents Contrast-Induced Nephropathy in Addition to Theophylline: A Randomized Controlled Trial.
abstract: In this study, we investigated whether hydration with sodium bicarbonate is superior to hydration with saline in addition to theophylline (both groups) in the prophylaxis of contrast-induced nephropathy (CIN). It was a prospective, randomized, double-blinded study in a university hospital on 2 general intensive care units (63% of investigations) and normal wards.After approval of the local ethics committee and informed consent 152 patients with screening serum creatinine ≥1.1 mg/dL and/or at least 1 additional risk factor for CIN undergoing intravascular contrast media (CM) exposure were randomized to receive a total of 9 mL/kg bicarbonate 154 mmol/L (group B; n = 74) or saline 0.9% (group S; n = 78) hydration within 7 h in addition to intravenous application of 200 mg theophylline. Serum creatinine was determined immediately before, 24 and 48 h after CM exposure. As primary endpoint we investigated the incidence of CIN (increase of serum creatinine ≥0.5 mg/dL and/or ≥25% within 48 h of CM).Both groups were comparable regarding baseline characteristics. Incidence of CIN was significantly less frequent with bicarbonate compared to sodium hydration (1/74 [1.4%] vs 7/78 [9.0%]; P = 0.035). Time course of serum creatinine was more favorable in group B with decreases in serum creatinine after 24 h (-0.084 mg/dL [95% confidence interval: -0.035 to -0.133 mg/dL]; P = 0.008) and 48 h (-0.093 mg/dL (-0.025 to -0.161 mg/dL); P = 0.007) compared to baseline which were not observed in group S.In patients at increased risk of CIN receiving prophylactic theophylline, hydration with sodium bicarbonate reduces contrast-induced renal impairment compared to hydration with saline.
authors.affiliation: From the II. Medizinische Klinik und Poliklinik (WH, AB, RMS), Klinik für Anaesthesiologie (SS), Klinik und Poliklinik für Vaskuläre und Endovaskuläre Chirurgie (TS) and Krankenhausapotheke (SB), Klinikum rechts der Isar der Technischen Universität München; München; Caritas-Krankenhaus St. Josef, Klinik für Urologie, Regensburg (TH); Kliniken des Landkreises Neumarkt i.d.OPf., Medizinische Klinik I, Neumarkt in der Oberpfalz (CS), Germany; and Universitätsklinik für Innere Medizin I, Landeskrankenhaus, Salzburg (MF), Austria.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Huber
authors.forename: Toni
authors.initials: T
authors.lastname: Huber
authors.forename: Stephan
authors.initials: S
authors.lastname: Baum
authors.forename: Michael
authors.initials: M
authors.lastname: Franzen
authors.forename: Christian
authors.initials: C
authors.lastname: Schmidt
authors.forename: Thomas
authors.initials: T
authors.lastname: Stadlbauer
authors.forename: Analena
authors.initials: A
authors.lastname: Beitz
authors.forename: Roland M
authors.initials: RM
authors.lastname: Schmid
authors.forename: Sebastian
authors.initials: S
authors.lastname: Schmid
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media / Q000009:adverse effects*; D003404:Creatinine / Q000097:blood; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D051437:Renal Insufficiency / Q000139:chemically induced* / Q000517:prevention & control*; D012307:Risk Factors; D017693:Sodium Bicarbonate / Q000008:administration & dosage / Q000627:therapeutic use*; D013806:Theophylline / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D003287:Contrast Media; D017693:Sodium Bicarbonate; D003404:Creatinine; D013806:Theophylline