Sodium bicarbonate vs sodium chloride for the prevention of contrast medium-induced nephropathy in patients...

Area of Science:

• Nephrology
• Cardiology
• Radiology

Background:

• Contrast medium-induced nephropathy (CMN) is a significant cause of renal failure.
• CMN is associated with increased hospitalization, costs, and mortality.
• Sodium bicarbonate is a potential prophylactic agent for CMN.

Purpose of the Study:

• To evaluate the efficacy of sodium bicarbonate versus sodium chloride in preventing CMN.
• The study focused on patients with moderate to severe chronic kidney dysfunction undergoing coronary angiography.

Main Methods:

• A randomized, controlled, single-blind study involving 353 patients with chronic kidney disease.
• Patients received either sodium chloride or sodium bicarbonate hydration before, during, and after coronary angiography.
• The primary endpoint was a ≥25% decrease in estimated glomerular filtration rate (eGFR) within four days post-contrast.

Main Results:

• No significant difference in CMN rates between sodium bicarbonate (13.3%) and sodium chloride (14.6%) groups (RR, 0.94; 95% CI, 0.55-1.60; P = .82).
• Rates of death, dialysis, myocardial infarction, and cerebrovascular events were similar between groups at 30 days and 30 days to 6 months.
• Baseline characteristics were comparable between the two treatment arms.

Conclusions:

• Sodium bicarbonate hydration is not superior to sodium chloride hydration for preventing CMN in high-risk patients.
• The findings do not support the routine use of sodium bicarbonate over sodium chloride for this indication.