ABSTRACT
BACKGROUND: Contrast-induced nephropathy is associated with increased in-hospital and long-term adverse clinical outcomes. METHODS AND RESULTS: To investigate whether hydration with sodium bicarbonate improves long-term clinical outcomes compared with sodium chloride, patients with chronic kidney disease undergoing an emergent coronary procedure were enrolled in a randomized clinical trial with > or = 1 year of follow-up. The 59 patients with chronic kidney disease (serum creatinine concentration > 1.1 mg/dl or estimated glomerular filtration rate < 60 ml/min) were randomly assigned to receive a 154 mmol/L intravenous infusion of either sodium bicarbonate (n = 30) or sodium chloride (n = 29). The electrolytes were given as a bolus of 3 ml.kg(-1).h(-1) for 1 h before the administration of contrast, followed by an infusion of 1 ml.kg(-1).h(-1) for 6 h during and after the procedure. During a mean follow-up period of 15.9+/-4.5 months, the incidence of renal replacement therapy or death was significantly lower in the sodium bicarbonate group than in the sodium chloride group (3% vs 21%, respectively; p = 0.037). CONCLUSIONS: Hydration with sodium bicarbonate reduces the incidence of renal replacement therapy and death in patients with chronic kidney disease undergoing an emergent coronary procedure.
Subject(s)
Kidney Failure, Chronic/chemically induced , Sodium Bicarbonate/therapeutic use , Sodium Chloride/therapeutic use , Aged , Aged, 80 and over , Contrast Media/adverse effects , Creatinine/blood , Emergencies , Female , Follow-Up Studies , Glomerular Filtration Rate , Humans , Kidney Failure, Chronic/drug therapy , Kidney Failure, Chronic/surgery , Male , Survival Analysis , SurvivorsABSTRACT
In the case of an emergency coronary procedure where the risk of contrast-induced nephropathy is especially high, there are few reliable methods to attenuate renal injury. We examined the efficacy of sodium bicarbonate for the prevention of contrast-induced nephropathy in patients undergoing an emergency coronary procedure. We enrolled 59 patients who were scheduled to undergo an emergency coronary angiography or intervention. These patients were randomized to receive a 154-mEq/L infusion of sodium bicarbonate (n = 30) or sodium chloride (n = 29), as a bolus of 3 ml/kg/hour for 1 hour before the administration of contrast, followed by an infusion of 1 ml/kg/hour for 6 hours during and after the procedure. In the sodium bicarbonate group, serum creatinine concentration remained unchanged within 2 days of contrast administration (1.31 +/- 0.52 to 1.31 +/- 0.59 mg/dl), whereas it increased in the sodium chloride group (1.32 +/- 0.65 to 1.52 +/- 0.92 mg/dl, p = 0.01). The incidence of contrast-induced nephropathy (an increase >0.5 mg/dl or >25% in serum creatinine concentration within 2 days of contrast) was significantly lower in the sodium bicarbonate group than in the sodium chloride group (7% vs 35%, p = 0.01, risk ratio 0.19, 95% confidence interval 0.046 to 0.80). In conclusion, hydration with sodium bicarbonate is more effective than with sodium chloride for the prevention of contrast-induced nephropathy in patients undergoing an emergency coronary procedure.