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Preventive effect of sodium bicarbonate Ringer's solution on post-contrast acute kidney injury in patients undergoing

Jialin Liu1, Wen Zhao1, Baobao Feng1,2

  • 1Department of Emergency, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China.

Frontiers in Pharmacology
|September 22, 2025
PubMed

Insights

Sodium bicarbonate Ringer's solution (BRS) shows promise in preventing post-contrast acute kidney injury (PC-AKI) after coronary angiography (CAG) and percutaneous coronary interventions (PCI). This study found a significantly lower incidence of PC-AKI in patients receiving BRS compared to normal saline.

Area of Science:

  • Nephrology
  • Cardiology
  • Pharmacology

Background:

  • Post-contrast acute kidney injury (PC-AKI) is a frequent complication following coronary angiography (CAG) and percutaneous coronary interventions (PCI).
  • Sodium bicarbonate Ringer's solution (BRS) has demonstrated efficacy in reducing postoperative acute kidney injury (AKI) and acid-base disorders in surgical and critically ill populations.
  • Limited research exists on the application of BRS for preventing PC-AKI.

Purpose of the Study:

  • To investigate the effectiveness and safety of BRS in preventing PC-AKI in patients undergoing CAG or PCI.
  • To compare the incidence of PC-AKI between patients treated with BRS and those treated with normal saline (NS).

Main Methods:

  • A prospective, randomized study involving patients with coronary atherosclerotic heart disease and stage 2-3b chronic kidney disease (CKD).
  • Participants received either BRS or NS for hydration at a rate of 1mL/kg/h from 3 hours pre- to 4 hours post-procedure.
  • Serum creatinine, cystatin C, and NGAL levels were monitored, with PC-AKI as the primary endpoint. Secondary endpoints included renal replacement therapy (RRT) and major adverse cardiovascular events (MACEs).

Main Results:

  • No significant differences in baseline characteristics or changes in Cys-C, NGAL, and electrolytes were observed between the BRS and NS groups.
  • The incidence of PC-AKI was significantly lower in the BRS group (1.3%) compared to the NS group (9.3%) (P = 0.029).
  • Multivariate logistic regression indicated a trend towards BRS reducing PC-AKI incidence (P = 0.054).

Conclusions:

  • BRS may be a more suitable prophylactic agent than NS for preventing PC-AKI in patients with mild-to-moderate renal dysfunction undergoing CAG/PCI.
  • Further research is warranted to confirm these findings and establish optimal protocols for BRS use in this patient population.
Abstract

Keywords:
contrastcoronary angiographyhydrationpercutaneous coronary interventionspost-contrast acute kidney injurysodium bicarbonate Ringer’s solution

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