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Sodium bicarbonate in preventing contrast nephropathy in patients at risk for volume overload: a randomized
Ali Vasheghani-Farahani1, Gelareh Sadigh, Seyed Ebrahim Kassaian
1Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran - Iran.
Insights
Sodium bicarbonate combined with half saline did not prevent contrast-induced nephropathy (CIN) more effectively than half saline alone in high-risk patients. This combination therapy offers no additional benefit for CIN prevention.
Area of Science:
- Nephrology
- Cardiology
- Pharmacology
Background:
- Contrast-induced nephropathy (CIN) is a risk following radiocontrast procedures.
- Sodium bicarbonate is explored as a prophylactic agent against CIN.
- High-risk patients with comorbidities require effective CIN prevention strategies.
Purpose of the Study:
- To evaluate the efficacy of sodium bicarbonate plus half saline versus half saline alone in preventing CIN.
- To compare these hydration strategies in patients with uncontrolled hypertension, heart failure, or pulmonary edema history.
Main Methods:
- A single-center, double-blind, randomized controlled trial was conducted.
- 72 patients with elevated creatinine undergoing coronary angiography were enrolled.
- Patients received either sodium bicarbonate plus half saline or half saline alone.
Main Results:
- No significant demographic or clinical differences were observed between groups.
- CIN incidence was 6.1% in the sodium bicarbonate group and 6.3% in the half saline group.
- The difference in CIN rates was not statistically significant (p=1.0).
Conclusions:
- Combination therapy with sodium bicarbonate and half saline does not provide added benefit over half saline alone for CIN prevention.
- Current hydration protocols with half saline are as effective as the combination therapy in this high-risk population.
Background:
Sodium bicarbonate has been recently proposed as a prophylactic measure for the prevention of contrast-induced nephropathy (CIN). We aimed to compare the efficacy of the combination of sodium bicarbonate with half saline, and half saline alone in preventing CIN in patients having uncontrolled hypertension, compensated severe heart failure or a history of pulmonary edema.
Methods:
Seventy-two patients undergoing elective coronary angiography with a serum creatinine level > or =1.5 mg/dL who had uncontrolled hypertension, compensated severe heart failure or a history of pulmonary edema were prospectively enrolled in a single-center, double-blind, randomized, controlled trial from August 2007 to July 2008 and were assigned to either an infusion of sodium bicarbonate plus half saline (n=36) or half saline alone (n=36). The primary end point was an absolute (> or =0.5 mg/dL) or relative (> or =25%) increase in serum creatinine 48 hours after the procedure (CIN).
Results:
There were no significant differences between the groups regarding their baseline demographic and biochemical characteristics, as well as the underlying disease. A total of 6.1% of the patients receiving sodium bicarbonate plus half saline developed CIN as opposed to 6.3% of the patients in the half saline group, which was not statistically different (odds ratio = 0.97; 95% confidence interval, 0.13-7.3; p=1.0).
Conclusion:
The combination therapy of sodium bicarbonate plus half saline does not offer additional benefits over hydration with half saline alone in the prevention of CIN.
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