Abstract 17645: Randomized Trial of 1-hour Sodium Bicarbonate Vs. Standard Saline Hydration in Patients With Chronic Kidney Disease Undergoing Intra-arterial Contrast Administration
Background: 1-hour bicarbonate hydration has been shown safe and effective in the prevention of contrast induced-acute kidney injury (CI-AKI) in chronic kidney disease (CKD) patients undergoing intravenous contrast enhanced-CT. The efficacy of this simple bicarbonate regime compared with standard peri-procedural saline hydration, which takes up to 8-24 hours, in patients undergoing intra-arterial contrast procedures is currently unknown.
Aim: To analyze whether 1-hour pre-procedural bicarbonate hydration (250ml, 1.4%) is non-inferior to standard peri-procedural saline infusion (total volume 2000ml, 0.9%) in CKD patients undergoing elective intra-arterial contrast administration (i.e. -coronary- angiography, percutaneous transluminal angioplasty, or endovascular aortic repair).
Methods: Primary outcome of this multicentre randomized trial was the serum creatinine increase 48-96 hours post contrast administration. Secondary outcomes were the incidence of CI-AKI (creatinine increase >25%/>0.5mg/dl), recovery of renal function, and the need for dialysis. Bicarbonate hydration was considered non-inferior if the mean relative creatinine increase was at most 15% higher compared with saline hydration.
Results: Between 2011 and 2014, 349 patients were randomized of whom 321 completed follow-up on the primary outcome (mean baseline eGFR 43ml/min, IQR 14ml/min). Mean creatinine increase was -1.0% (IQR 18%) in the bicarbonate and -2.4% (IQR 17%) in the saline arm, mean difference 1.3%(95%CI -2.0 to 4.7), p-non-inferiority <0.001. The incidence of CI-AKI was 4.3% (7/162) in the bicarbonate vs. 2.5% (4/159) in the saline arm, RR 1.7(95%CI 0.5-5.8), with renal function recovering within 2 months in 57.1% (4/7) and 100.0% (4/4) of CI-AKI patients, respectively, (p-value 0.1). None of the patients developed a need for dialysis.
Conclusion: 1-hour bicarbonate hydration was non-inferior to saline in CKD patients undergoing intra-arterial contrast procedures, with a non-significant higher CI-AKI risk in the bicarbonate group. As the absolute CI-AKI risks were low, the brief bicarbonate regime can be safely used in daily practice, which can lead to important reductions in hospitalisation length and costs.
Author Disclosures: J. Kooiman: None. J.P. de Vries: None. J. Van der Heyden: None. Y.W. Sijpkens: None. P.R. van Dijkman: None. J.J. Wever: None. H. van Overhagen: None. A.C. Vahl: None. N.J. Aarts: None. I.J. Verberk: None. H.F. Brulez: None. J.F. Hamming: None. A.J. Van der Molen: None. S.C. Cannegieter: None. H. Putter: None. W.B. Van den Hout: None. T.J. Rabelink: None. M.V. Huisman: None.
- © 2014 by American Heart Association, Inc.