Prevention of Contrast-Induced Nephropathy With Sodium Bicarbonate: A Randomized Controlled Trial
2004
ContextContrast-induced nephropathy remains a common complication of radiographic
procedures. Pretreatment with sodium bicarbonate is more protective than sodium
chloride in animal models of acute ischemic renal failure. Acute renal failure
from both ischemia and contrast are postulated to occur from free-radical
injury. However, no studies in humans or animals have evaluated the efficacy
of sodium bicarbonate for prophylaxis against contrast-induced nephropathy.ObjectiveTo examine the efficacy of sodium bicarbonate compared with sodium chloride
for preventive hydration before and after radiographic contrast.Design, Setting, and PatientsA prospective, single-center, randomized trial conducted from September
16, 2002, to June 17, 2003, of 119 patients with stable serum creatinine levels
of at least 1.1 mg/dL (≥97.2 µmol/L) who were randomized to receive
a 154-mEq/L infusion of either sodium chloride (n = 59) or sodium bicarbonate
(n = 60) before and after iopamidol administration (370 mg iodine/mL). Serum
creatinine levels were measured at baseline and 1 and 2 days after contrast.InterventionsPatients received 154 mEq/L of either sodium chloride or sodium bicarbonate,
as a bolus of 3 mL/kg per hour for 1 hour before iopamidol contrast, followed
by an infusion of 1 mL/kg per hour for 6 hours after the procedure.Main Outcome MeasureContrast-induced nephropathy, defined as an increase of 25% or more
in serum creatinine within 2 days of contrast.ResultsThere were no significant group differences in age, sex, incidence of
diabetes mellitus, ethnicity, or contrast volume. Baseline serum creatinine
was slightly higher but not statistically different in patients receiving
sodium bicarbonate treatment (mean [SD], 1.71 [0.42] mg/dL [151.2 {37.1} µmol/L]
for sodium chloride and 1.89 [0.69] mg/dL [167.1 {61.0} µmol/L] for
sodium bicarbonate; P = .09). The primary end point
of contrast-induced nephropathy occurred in 8 patients (13.6%) infused with
sodium chloride but in only 1 (1.7%) of those receiving sodium bicarbonate(mean
difference, 11.9%; 95% confidence interval [CI], 2.6%-21.2%; P = .02). A follow-up registry of 191 consecutive patients receiving
prophylactic sodium bicarbonate and meeting the same inclusion criteria as
the study resulted in 3 cases of contrast-induced nephropathy (1.6%; 95% CI,
0%-3.4%).ConclusionHydration with sodium bicarbonate before contrast exposure is more effective
than hydration with sodium chloride for prophylaxis of contrast-induced renal
failure.
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