Abstract 2846: Prevention of Contrast-Induced Nephropathy with Sodium Bicarbonate in Patients Undergoing an Emergent Coronary Procedure: A Prospective Randomized Controlled Trial
Background: Contrast-Induced Nephropathy (CIN) remains a common complication of radiographic procedure. CIN is postulated to occur from free radical injury, which may be reduced by alkalizing renal tubular fluid with bicarbonate. However, there is no information available on the efficacy of sodium bicarbonate for the prophylaxis against CIN in patients undergoing an emergent coronary procedure.
Methods: We enrolled 56 patients who had renal dysfunction (serum creatinine > 1.1mg/dl or glomerular filtration rate < 60ml/min) and underwent an emergent coronary angiography or intervention. These patients were randomized to receive a 154mEq/l infusion of either sodium chloride (n=28) or sodium bicarbonate (n=28), as a bolus of 3ml/Kg/h for 1 hour before the administration of contrast, followed by an infusion of 1ml/Kg/h for 6 hours during and after the procedure. Serum creatinine levels were measured at baseline and 1 and 2 days after contrast. Primary end point was development of CIN. CIN was defined as an increase of ≥ 0.5mg/dl or ≥ 25% in serum creatinine within 2 days of contrast.
Results: There were no significant group differences in age, sex, incidence of diabetes mellitus (sodium bicarbonate, 32% vs. sodium chloride, 36%), contrast volume (110±89 vs. 119±69ml), left ventricular ejection fraction (58±12% vs. 55±13%) or baseline serum creatinine. In patients infused with sodium bicarbonate, there was no significant change in the serum creatinine after the contrast administration (1.26±0.49 to 1.29±0.60mg/dl), while it significantly increased in those with sodium chloride (1.24±0.44 to 1.37±0.71mg, p<0.05). The incidence of CIN was significantly lower in patients infused with sodium bicarbonate than that with sodium chloride (7% vs. 32%, P<0.05, RR=0.22, 95%CI=0.052–0.95).
Conclusion: In patients undergoing emergent cardiac catheterization, hydration with sodium bicarbonate is more effective than hydration with sodium chloride for the prevention of CIN.