CLINICAL RESEARCH: INVASIVE CARDIOLOGY
Sodium Bicarbonate Versus Saline for the Prevention of Contrast-Induced Nephropathy in Patients With Renal Dysfunction Undergoing Coronary Angiography or Intervention
Mauro Maioli, MD*,
Anna Toso, MD,
Mario Leoncini, MD,
Michela Gallopin, MD,
Delio Tedeschi, MD,
Carlo Micheletti, RN and
Francesco Bellandi, MD
Division of Cardiology, Misericordia e Dolce Hospital, Prato, Italy.
Manuscript received March 7, 2008;
revised manuscript received May 5, 2008,
accepted May 5, 2008.
* Reprint requests and correspondence: Dr. Mauro Maioli, Via degli Arcipressi 3, 50143, Florence, Italy. (Email: mauro.maioli{at}fastwebnet.it).
Objectives: The purpose of this study was to compare the efficacy of sodium bicarbonate versus isotonic saline in addition to N-acetylcysteine (NAC) to prevent contrast-induced nephropathy (CIN) in a larger population of patients with renal dysfunction undergoing coronary angiography or intervention.
Background: Contrast-induced nephropathy accounts for more than 10% of hospital-acquired renal failure. Recent studies suggest that hydration with sodium bicarbonate is more protective than isotonic saline in the prevention of CIN.
Methods: The prospective, single center study included 502 patients with estimated creatinine clearance <60 ml/min, randomized to receive infusion of either saline or sodium bicarbonate before and after iso-osmolar contrast medium administration. All patients received oral NAC 600 mg twice a day. Contrast-induced nephropathy was defined as an absolute increase of serum creatinine  0.5 mg/dl measured within 5 days.
Results: Contrast-induced nephropathy occurred in 54 patients (10.8%); 25 (10%) were treated with sodium bicarbonate and 29 (11.5%) with saline (p = 0.60). In patients with CIN, the mean increase in creatinine was not significantly different in the 2 study groups (0.9 ± 0.6 mg/dl vs. 0.7 ± 0.2 mg/dl, respectively; p = 0.15). Only 2 patients needed temporary hemofiltration.
Conclusions: Hydration with sodium bicarbonate plus NAC before contrast medium exposure is not more effective than hydration with isotonic saline plus NAC for prophylaxis of CIN in patients with moderate-to-severe renal dysfunction. (Sodium Bicarbonate Versus Saline for the Prevention of Contrast-Induced Nephropathy; NCT00606827
[ClinicalTrials.gov]
)
Key Words: contrast-induced nephropathy • contrast media • angiography • angioplasty
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Abbreviations and Acronyms
| | CI = confidence interval | | CIN = contrast-induced nephropathy | | NAC = N-acetylcysteine | | OR = odds ratio |
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