Sodium Bicarbonate Therapy for the Prevention of Contrast-Induced Acute Kidney Injury

Jang, Jae‐Sik; Jin, Han-Young; Seo, Jeong-Sook; Yang, Tae–Hyun; Kim, Dae-Kyeong; Kim, Tae Hee; Urm, Sang‐Hwa; Kim, Dong-Soo; Kim, Dong-Kie; Seol, Sang–Hoon; Kim, Doo-Il; Cho, Kyoung-Im; Kim, Bo‐Hyun; Park, Yong Hyun; Je, Hyung-Gon; Ahn, Jung‐Min; Kim, Won‐Jang; Lee, Jong–Young; Lee, Seung-Whan

doi:10.1253/circj.cj-12-0096

Cited by 82 publications

(45 citation statements)

References 65 publications

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“…The available studies considered in a large number of meta-analyses, which are unfortunately heterogeneous and for the most part poorly conducted (especially as concerns older studies), lead to conflicting results [126][127][128][129][130][131]. Moreover, in more recent metaanalyses positive results favouring NAC are demonstrated only when they include published trials.…”

Section: (Grade 2+) Strong Agreementmentioning

confidence: 99%

Acute kidney injury in the perioperative period and in intensive care units (excluding renal replacement therapies)

Ichai

Vinsonneau

Souweine

et al. 2016

Anaesthesia Critical Care & Pain Medicine

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Acute kidney injury (AKI) is a syndrome that has progressed a great deal over the last 20 years. The decrease in urine output and the increase in classical renal biomarkers, such as blood urea nitrogen and serum creatinine, have largely been used as surrogate markers for decreased glomerular filtration rate (GFR), which defines AKI. However, using such markers of GFR as criteria for diagnosing AKI has several limits including the difficult diagnosis of non-organic AKI, also called "functional renal insufficiency" or "pre-renal insufficiency". This situation is characterized by an oliguria and an increase in creatininemia as a consequence of a reduction in renal blood flow related to systemic haemodynamic abnormalities. In this situation, "renal insufficiency" seems rather inappropriate as kidney function is not impaired. On the contrary, the kidney delivers an appropriate response aiming to recover optimal systemic physiological haemodynamic conditions. Considering the kidney as insufficient is erroneous because this suggests that it does not work correctly, whereas the opposite is occurring, because the kidney is healthy even in a threatening situation. With current definitions of AKI, normalization of volaemia is needed before defining AKI in order to avoid this pitfall.

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Section: (Grade 2+) Strong Agreementmentioning

confidence: 99%

Acute kidney injury in the perioperative period and in intensive care units (excluding renal replacement therapies)

Ichai

Vinsonneau

Souweine

et al. 2016

Anaesthesia Critical Care & Pain Medicine

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“…However, this was on the basis of a small number of events (n=21 in those undergoing coronary angiography) and may be the result of chance, particularly as the mechanism of the interaction is unclear. A recent observational trial (15) and two meta-analyses of bicarbonate versus saline trials for the prevention of CIAKI also found a similar point estimate for a benefit of bicarbonate on mortality (16,17). This issue will clearly require further confirmation in appropriately powered randomized trials and study of mechanism.…”

Section: Discussionmentioning

confidence: 86%

Randomized Trial of Bicarbonate or Saline Study for the Prevention of Contrast-Induced Nephropathy in Patients with CKD

Solomon

Gordon

Manoukian

et al. 2015

Clinical Journal of the American Society of Nephrology

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Background and objectives Sodium bicarbonate has been proposed for protection of the kidney from contrastinduced AKI (CIAKI). However, the effects of bicarbonate on long-term important clinical outcomes are uncertain.Design, setting, participants, & measurements In a prospective, double-blind, multicenter randomized clinical trial, 391 patients with an eGFR,45 ml/min per 1.73 m 2 undergoing elective coronary or peripheral angiography were randomized to an infusion with a high dose of isotonic sodium bicarbonate (target 2.0 mEq/kg) or a similar molar amount of isotonic sodium chloride. The primary outcome was a composite of mortality, dialysis, or a sustained 20% reduction in eGFR at 6 months.Results There were 391 patients enrolled between March 2010 and May 2012. The incidence of the primary outcome was 14.9% in the bicarbonate group and 16.3% in the control group in the intention-to-treat population (P=0.78). There was also no difference in the incidence of CIAKI between the treatment groups (14.5% versus 12.1%, respectively; P=0.20). CIAKI was associated with a higher incidence of sustained loss of kidney function at 6 months compared with those without CIAKI (21.2% versus 7.7%, respectively; P=0.06).Conclusions High-dose sodium bicarbonate infusion in patients with eGFR,45 ml/min per 1.73 m 2 undergoing angiography did not demonstrate a difference in incidence of the composite of death, dialysis, or sustained 6-month reduction in eGFR or CIAKI compared with sodium chloride.

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“…However, recent evidence 49 indicates that sodium bicarbonate hydration is significantly more protective against CI-AKI than is hydration with physiological saline. Oral and intravenous fluid hydration should be paired to maximize the fluid bolus before cardiac catheterization to allow patient-empowered self-hydration to help prevent CI-AKI if intravenous fluids are not administered before and after the procedure.…”

Section: Discussionmentioning

confidence: 99%

Reducing Acute Kidney Injury Due to Contrast Material: How Nurses Can Improve Patient Safety

Lambert

Chaisson

Horton

et al. 2017

Critical Care Nurse

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BACKGROUND Acute kidney injury due to contrast material occurs in 3% to 15% of the 2 million cardiac catheterizations done in the United States each year. OBJECTIVE To reduce acute kidney injury due to contrast material after cardiovascular interventional procedures. METHODS Nurse leaders in the Northern New England Cardiovascular Disease Study Group, a 10-center quality improvement consortium in Maine, New Hampshire, and Vermont, formed a nursing task force to reduce acute kidney injury due to contrast material after cardiovascular interventional procedures. Data were prospectively collected January 1, 2007, through June 30, 2012, on consecutive nonemergent patients (n = 20 147) undergoing percutaneous coronary interventions. RESULTS Compared with baseline rates, adjusted rates of acute kidney injury among the 10 centers were significantly reduced by 21% and by 28% in patients with baseline estimated glomerular filtration rate less than 60 mL/min per 1.73 m2. Key qualitative system factors associated with improvement included use of multidisciplinary teams, standardized fluid orders, use of an intravenous fluid bolus, patient education about oral hydration, and limiting the volume of contrast material. CONCLUSIONS Standardization of evidence-based best practices in nursing care may reduce the incidence of acute kidney injury due to contrast material.

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Sodium Bicarbonate Therapy for the Prevention of Contrast-Induced Acute Kidney Injury

Cited by 82 publications

References 65 publications

Acute kidney injury in the perioperative period and in intensive care units (excluding renal replacement therapies)

Acute kidney injury in the perioperative period and in intensive care units (excluding renal replacement therapies)

Randomized Trial of Bicarbonate or Saline Study for the Prevention of Contrast-Induced Nephropathy in Patients with CKD

Reducing Acute Kidney Injury Due to Contrast Material: How Nurses Can Improve Patient Safety

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