Comparison of normal saline, ringer's lactate, and sodium bicarbonate for prevention of contrast-induced nephropathy in patients with coronary angiography: A randomized double-blind clinical trial

Abstract

Contrast-induced nephropathy (CIN) is one the most important renal complications following contrast injection in percutaneous coronary intervention. We compared the protective effect of normal saline (NLS), Ringer's lactate (RL), and sodium bicarbonate (Bi). In this study, patients with coronary angiography indication were divided into three groups by simple randomization method: NLS, RL, and Bi solution groups. Creatinine (Cr) alterations, glomerular filtration rate, and urine pH were evaluated prior and after the procedure. Data were analyzed with SPSS and P value less than 0.05 was taken as significant. In this study, 300 patients [150 men (50%), mean age 59.1 ± 10.6 years] were studied. The CIN incidence overall was 10% (30 patients): 8.3% (8 patients) in NLS; 16.5% (17 patients) in RL; and 5% (5 patients) in Bi group. It was significantly different among three groups ( P = 0.018), and CIN incidence was significantly lower in Bi vs. RL group ( P = 0.012). Baseline Cr clearance was higher in patients who developed CIN (78.4 ± 26.0 vs. 69.8 ± 21.6 mL/dL, P = 0.044). Urine pH after trial in CIN group was lower than the patients without CIN (5.5 ± 1.4 vs. 6.3 ± 1.8 mL/dL, P = 0.024). Higher urine pH and its change during study were seen in Bi group ( P < 0.05). Cr at the initiation of study and the use of RL vs. Bi may be prognostic factors in CIN progression ( P < 0.002). Sodium barcarbonate as fluid had more protective effect than NSL or RL on prevention of CIN in patients undergoing coronary angiography. The risk factors for CIN in our study were higher baseline serum Cr and use of RL as hydration fluid.

Evaluating the Association between Contrast Medium Dosage and Acute Kidney Injury in Transcatheter Aortic Valve Replacement Using Different Predictive Models

“…A lack of consensus regarding what fluids should be used for prehydration therapy to prevent contrast-associated nephropathy also means that our institution's use of Ringers lactate was in accordance with recommendations by the American College of Radiology [44], but diverged from the guidelines set by European Society of Cardiology/European Association for Cardio-Thoracic Surgery [45]. A recent study in patients undergoing angioplasty or angiography though, showed similar incidences of contrast induced nephropathy (CIN) with either option suggesting that the choice in protocol is unlikely to have altered our findings [46]. Nevertheless, daily serum creatine measurements during the initiation phase of TAVR at our center were only performed during the first 72 h whereas the VARC-2 criteria suggest that the AKI diagnosis period should be extended up to 7 days [28].…”

Effect of No Prehydration vs Sodium Bicarbonate Prehydration Prior to Contrast-Enhanced Computed Tomography in the Prevention of Postcontrast Acute Kidney Injury in Adults With Chronic Kidney Disease

“…Sodium bicarbonate hydration has been the subject of several recent randomized clinical trials and reviews. 8,9,17,[22][23][24][25][26][27][28] Weisbord et al 23 reported no benefit of periprocedural admin-istration of intravenous isotonic sodium bicarbonate over intravenous isotonic sodium chloride among patients with impaired kidney function undergoing angiography. Prehydration with 250 mL of sodium bicarbonate has previously been shown to be noninferior to prehydration with 1 L of saline and posthydration with 1 L of saline in the prevention of PC-AKI in a noninferiority trial conducted by our study group.…”

“…Sodium bicarbonate hydration has been the subject of several recent randomized clinical trials and reviews . Weisbord et al reported no benefit of periprocedural administration of intravenous isotonic sodium bicarbonate over intravenous isotonic sodium chloride among patients with impaired kidney function undergoing angiography.…”

Hemorrhagic, hypovolemic shock resuscitated with Ringer’s solution using bicarbonate versus lactate: A CONSORT-randomized controlled study comparing patient outcomes and blood inflammatory factors

“…[17] Sodium bicarbonate Ringer's solution is a new formulation of crystalloid solution composed of sodium, magnesium, potassium, and calcium ions. [18] Sodium bicarbonate Ringer's solution has been demonstrated to have a beneficial clinical effect in supplementing circulating blood volume and improving metabolic acidosis. [19,20] In the early stage of shock, the body's inflammatory system is also stimulated, and many inflammatory factors are released into the blood, which can potentially evolve into the systemic inflammatory response syndrome.…”

“…[17] Sodium bicarbonate Ringer’s solution is a new formulation of crystalloid solution composed of sodium, magnesium, potassium, and calcium ions. [18] Sodium bicarbonate Ringer’s solution has been demonstrated to have a beneficial clinical effect in supplementing circulating blood volume and improving metabolic acidosis. [19,20]…”