Sodium Bicarbonate Versus Sodium Chloride for Preventing Contrast-Associated Acute Kidney Injury in Critically Ill Patients: A Randomized Controlled Trial.
OBJECTIVE
To test whether hydration with bicarbonate rather than isotonic sodium chloride reduces the risk of contrast-associated acute kidney injury in critically ill patients.


METHODS
Prospective, double-blind, multicenter, randomized controlled study.


METHODS
Three French ICUs.


METHODS
Critically ill patients with stable renal function (n = 307) who received intravascular contrast media.


METHODS
Hydration with 0.9% sodium chloride or 1.4% sodium bicarbonate administered with the same infusion protocol: 3 mL/kg during 1 hour before and 1 mL/kg/hr during 6 hours after contrast medium exposure.


RESULTS
The primary endpoint was the development of contrast-associated acute kidney injury, as defined by the Acute Kidney Injury Network criteria, 72 hours after contrast exposure. Patients randomized to the bicarbonate group (n = 151) showed a higher urinary pH at the end of the infusion than patients randomized to the saline group (n = 156) (6.7 ± 2.1 vs 6.2 ± 1.8, respectively; p < 0.0001). The frequency of contrast-associated acute kidney injury was similar in both groups: 52 patients (33.3%) in the saline group and 53 patients (35.1%) in the bicarbonate group (absolute risk difference, -1.8%; 95% CI [-12.3% to 8.9%]; p = 0.81). The need for renal replacement therapy (five [3.2%] and six [3.9%] patients; p = 0.77), ICU length of stay (24.7 ± 22.9 and 23 ± 23.8 d; p = 0.52), and mortality (25 [16.0%] and 24 [15.9%] patients; p > 0.99) were also similar between the saline and bicarbonate groups, respectively.


CONCLUSIONS
Except for urinary pH, none of the outcomes differed between the two groups. Among ICU patients with stable renal function, the benefit of using sodium bicarbonate rather than isotonic sodium chloride for preventing contrast-associated acute kidney injury is marginal, if any.
1Department of Medical Intensive Care, CHU de Caen, Caen, France.2Department of Anesthesiology and Surgical Intensive Care, CHU de Caen, Caen, France.3Department of Intensive Care, Centre Hospitalier General Mémorial France Etats-Unis, Saint Lô, France.4Department of Biostatistics and Clinical Research, CHU de Caen, Caen, France.5Université de Caen Normandie, Caen, France.
Xavier
X
Valette
Isabelle
I
Desmeulles
Benoit
B
Savary
Romain
R
Masson
Amélie
A
Seguin
Bertrand
B
Sauneuf
Jennifer
J
Brunet
Pierre
P
Verrier
Véronique
V
Pottier
Marie
M
Orabona
Désiré
D
Samba
Gérald
G
Viquesnel
Mathilde
M
Lermuzeaux
Pascal
P
Hazera
Jean-Jacques
JJ
Dutheil
Jean-Luc
JL
Hanouz
Jean-Jacques
JJ
Parienti
Damien
D
du Cheyron
D058186:Acute Kidney Injury / Q000209:etiology / Q000517:prevention & control* / Q000652:urine; D000328:Adult; D000368:Aged; D003287:Contrast Media / Q000009:adverse effects; D016638:Critical Illness / Q000628:therapy; D004311:Double-Blind Method; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D017052:Hospital Mortality; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D017582:Renal Replacement Therapy; D017693:Sodium Bicarbonate / Q000008:administration & dosage / Q000627:therapeutic use*; D012965:Sodium Chloride / Q000008:administration & dosage / Q000627:therapeutic use*
D003287:Contrast Media; D012965:Sodium Chloride; D017693:Sodium Bicarbonate