Comparison of Usefulness of Sodium Bicarbonate Versus Sodium Chloride to Prevent Contrast-Induced Nephropathy in Patients Undergoing an Emergent Coronary Procedure

• Published in: The American journal of cardiology Vol. 100; no. 5; pp. 781 - 786
• Main Authors: Masuda, Masaharu, MD, Yamada, Takahisa, MD, PhD, Mine, Takanao, MD, PhD, Morita, Takashi, MD, PhD, Tamaki, Shunsuke, MD, Tsukamoto, Yasumasa, MD, Okuda, Keiji, MD, Iwasaki, Yuusuke, MD, Hori, Masatsugo, MD, PhD, Fukunami, Masatake, MD, PhD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.09.2007; Elsevier; Elsevier Limited
• Subjects: Aged; Angioplasty, Balloon, Coronary; Biological and medical sciences; Cardiology. Vascular system; Cardiovascular; Chemical compounds; Clinical trials; Comparative analysis; Contrast Media - adverse effects; Coronary Angiography; Coronary heart disease; Creatinine - blood; Disease prevention; Female; Fluid Therapy; Follow-Up Studies; Glomerular Filtration Rate - drug effects; Heart; Humans; Iopamidol - adverse effects; Kidney diseases; Kidney Diseases - chemically induced; Kidney Diseases - prevention & control; Male; Medical imaging; Medical sciences; Risk Factors; Sodium Bicarbonate - administration & dosage; Sodium Bicarbonate - therapeutic use; Sodium Chloride - administration & dosage; Sodium Chloride - therapeutic use; Stroke Volume - drug effects; Time Factors; Kidney disease; Human; Urinary system disease; Toxicity; Coronary artery; Cardiovascular disease; Patient; Coronary heart disease; Phlebology; Hydrogencarbonates; Prevention; Nephropathy; Sodium; Chlorides; Radioopaque marker; Procedure; Circulatory system; Cardiology; Comparative study; Contrast media
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2007.03.098

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.