Sodium bicarbonate plus isotonic saline versus saline for prevention of contrast-induced nephropathy in patients undergoing coronary angiography: a randomized controlled trial

Am J Kidney Dis. 2009 Oct;54(4):610-8. doi: 10.1053/j.ajkd.2009.05.016. Epub 2009 Jul 19.

Abstract

Background: There is controversy about the prophylactic measures proposed for the prevention of contrast-induced nephropathy (CIN). We aim to compare the efficacy of the combination of sodium bicarbonate and isotonic saline and that of isotonic saline alone in preventing CIN.

Study design: Randomized double-blind controlled trial.

Setting & participants: 265 consecutive patients 18 years or older with a serum creatinine level of 1.5 mg/dL or greater undergoing elective coronary angiography from August 2007 to June 2008 in Tehran Heart Center, Tehran, Iran.

Intervention: Study participants were randomly assigned to receive either 75 mL of 8.4% sodium bicarbonate added to 1 L of isotonic saline (n = 135) or isotonic saline alone (n = 130) as a bolus of 3 mL/kg for 1 hour before contrast injection, followed by an infusion of 1 mL/kg/h for 6 hours after the procedure.

Outcomes & measurements: The primary end point was an absolute (>or=0.5 mg/dL) or relative (>or=25%) increase in serum creatinine level 48 hours after the procedure (CIN).

Results: There were no significant differences between the bicarbonate and saline groups regarding baseline demographic and biochemical characteristics, including baseline serum creatinine level (1.63 +/- 0.32 [SD] versus 1.66 +/- 0.50 mg/dL), baseline glomerular filtration rate (46.4 +/- 12 versus 45.4 +/- 12 mL/min/1.73 m(2)), and baseline urine pH (5.42 +/- 0.6 versus 5.46 +/- 0.8). Nine patients (7.4%) receiving sodium bicarbonate developed CIN as opposed to 7 patients (5.9%) in the saline group, which was not statistically different (odds ratio, 1.26; 95% confidence interval, 0.45 to 3.50; P = 0.6).

Limitations: The trial did not follow up participants to assess need for dialysis and mortality rate.

Conclusion: The combination therapy of sodium bicarbonate plus saline does not offer additional benefits over hydration with saline alone in the prevention of CIN.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Kidney Injury / blood
  • Acute Kidney Injury / chemically induced*
  • Acute Kidney Injury / physiopathology
  • Acute Kidney Injury / prevention & control*
  • Aged
  • Biomarkers / blood
  • Contrast Media / administration & dosage
  • Contrast Media / adverse effects*
  • Coronary Angiography* / methods
  • Creatinine / blood
  • Double-Blind Method
  • Drug Therapy, Combination
  • Female
  • Fluid Therapy / methods*
  • Follow-Up Studies
  • Humans
  • Infusions, Intravenous
  • Injections, Intravenous
  • Iohexol / adverse effects
  • Male
  • Middle Aged
  • Odds Ratio
  • Sodium Bicarbonate / administration & dosage*
  • Sodium Chloride / administration & dosage*
  • Time Factors
  • Treatment Outcome
  • Triiodobenzoic Acids / adverse effects

Substances

  • Biomarkers
  • Contrast Media
  • Triiodobenzoic Acids
  • Iohexol
  • Sodium Chloride
  • Sodium Bicarbonate
  • Creatinine
  • iodixanol