A New Protocol Using Sodium Bicarbonate for the Prevention of Contrast-Induced Nephropathy in Patients Undergoing Coronary Angiography
What is the relative efficacy of sodium bicarbonate versus normal saline in preventing contrast-induced nephropathy (CIN)?
The authors randomized 155 patients with a glomerular filtration rate (GFR) <60 ml/min/1.73 m2 who were undergoing coronary angiography to sodium chloride plus sodium bicarbonate (bicarbonate group, n = 78) or sodium chloride alone (chloride group, n = 77). All patients received normal saline 12 hours before and after the procedure. Infusion of sodium bicarbonate at 1 ml/kg/h was started 3 hours before and continued 6 hours after coronary angiography. CIN was defined as either a 25% increase in serum creatinine or an absolute increase of ≥0.5 mg/dl within 2 days of the procedure.
There was no difference in the baseline GFR between the two groups. Randomization to bicarbonate was associated with a higher GFR compared with sodium chloride on day 2 (45.8 ± 13.4 vs. 40.9 ± 14.6 ml/min/1.73 m2, p = 0.031) and at 1 month (49.5 ± 14.7 vs. 43.7 ± 15.5 ml/min/1.73 m2, p = 0.019). Randomization to bicarbonate was associated with a reduction in incidence of CIN (13% vs. 2.6%, p = 0.012).
The authors concluded that randomization to bicarbonate was associated with a reduction in the incidence of CIN in patients undergoing angiography.
Multiple studies have compared sodium bicarbonate versus normal saline-based hydration for prophylaxis of CIN, and in general, there is a reduction in the incidence of CIN with bicarbonate (Meier, et al., BMC Med 2009;7:23). There has, however, been no evidence of reduction in harder endpoints with sodium bicarbonate-based hydration, and most of the larger studies comparing it to saline-based hydration have found no difference in outcome between the two strategies (Brar, et al., JAMA 2008;300:1038-46). Prevention of CIN requires adequate hydration with either saline or sodium bicarbonate and minimization of contrast volume.
Keywords: Kidney Diseases, Kidney Function Tests, Coronary Angiography, Bicarbonates, Glomerular Filtration Rate, Sodium Bicarbonate
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