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Sodium bicarbonate vs sodium chloride for the prevention of contrast medium-induced nephropathy in patients
Somjot S Brar1, Albert Yuh-Jer Shen, Michael B Jorgensen
1Center for Interventional Vascular Therapy, Columbia University Medical Center, 161 Fort Washington Ave, Fifth Floor, New York, NY 10032, USA. sbrar@cvri.org
Insights
Sodium bicarbonate hydration did not prove superior to sodium chloride for preventing contrast-induced nephropathy in patients with chronic kidney disease undergoing coronary angiography. Outcomes were similar between the two hydration groups.
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.
Context:
Sodium bicarbonate has been suggested as a possible strategy for prevention of contrast medium-induced nephropathy, a common cause of renal failure associated with prolonged hospitalization, increased health care costs, and substantial morbidity and mortality.
Objective:
To determine if sodium bicarbonate is superior to sodium chloride for preventing contrast medium-induced nephropathy in patients with moderate to severe chronic kidney dysfunction who are undergoing coronary angiography.
Design, Setting, And Patients:
Randomized, controlled, single-blind study conducted between January 2, 2006, and January 31, 2007, and enrolling 353 patients with stable renal disease who were undergoing coronary angiography at a single US center. Included patients were 18 years or older and had an estimated glomerular filtration rate of 60 mL/min per 1.73 m(2) or less and 1 or more of diabetes mellitus, history of congestive heart failure, hypertension, or age older than 75 years.
Interventions:
Patients were randomized to receive either sodium chloride (n = 178) or sodium bicarbonate (n = 175) administered at the same rate (3 mL/kg for 1 hour before coronary angiography, decreased to 1.5 mL/kg per hour during the procedure and for 4 hours after the completion of the procedure).
Main Outcome Measure:
The primary end point was a 25% or greater decrease in the estimated glomerular filtration rate on days 1 through 4 after contrast exposure.
Results:
Median patient age was 71 (interquartile range, 65-76) years, and 45% had diabetes mellitus. The groups were well matched for baseline characteristics. The primary end point was met in 13.3% of the sodium bicarbonate group and 14.6% of the sodium chloride group (relative risk, 0.94; 95% confidence interval, 0.55-1.60; P = .82). In patients randomized to receive sodium bicarbonate vs sodium chloride, the rates of death, dialysis, myocardial infarction, and cerebrovascular events did not differ significantly at 30 days (1.7% vs 1.7%, 0.6% vs 1.1%, 0.6% vs 0%, and 0% vs 2.2%, respectively) or at 30 days to 6 months (0.6% vs 2.3%, 0.6% vs 1.1%, 0.6% vs 2.3%, and 0.6% vs 1.7%, respectively) (P > .10 for all).
Conclusion:
The results of this study do not suggest that hydration with sodium bicarbonate is superior to hydration with sodium chloride for the prevention of contrast medium-induced nephropathy in patients with moderate to severe chronic kidney disease who are undergoing coronary angiography.
Trial Registration:
clinicaltrials.gov Identifier: NCT00312117.
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