Sodium bicarbonate versus saline for the prevention of contrast-induced nephropathy in patients with renal dysfunction undergoing coronary angiography or intervention.

Full Abstract

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 > or =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).

Author information

Author/s: Maioli, Mauro (M); Toso, Anna (A); Leoncini, Mario (M); Gallopin, Michela (M); Tedeschi, Delio (D); Micheletti, Carlo (C); Bellandi, Francesco (F);

Affiliation: Division of Cardiology, Misericordia e Dolce Hospital, Prato, Italy. mauro.maioli(-atsign-)fastwebnet.it <mauro.maioli(-atsign-)fastwebnet.it>

Journal and publication information

Publication Type: Comparative Study; Journal Article; Randomized Controlled Trial

Journal: Journal of the American College of Cardiology (J Am Coll Cardiol), published in United States. (Language: eng)

Reference: 2008-Aug; vol 52 (issue 8) : pp 599-604

Dates: Created 2008/08/15; Completed 2008/09/16;

PMID: 18702961, status: MEDLINE (last retrieved date: 2/18/2009)

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