Sodium Bicarbonate vs Sodium Chloride for the Prevention of Contrast Medium–Induced Nephropathy in Patients Undergoing Coronary Angiography

Abstract

ONTRAST MEDIUM-INDUCED NEphropathy is a recognized complication of exposure to iodine contrast media. It is a common cause of renal failure associated with prolonged hospitalization, increased health care costs, and substantial morbidity and mortality. [1][2][3] The reported incidence of contrast-induced nephropathy ranges from 2% in lowrisk populations to 50% in high-risk populations. [3][4][5] Risk factors for development of this complication include chronic kidney disease, volume and type of contrast, and patient-related factors such as diabetes, congestive heart failure, advanced age, anemia, sex, and reduced effective circulating volume. 2,[6][7][8][9] The mechanism of contrast mediuminduced nephropathy remains unknown but may be related to renal vasoconstriction resulting in medullary ischemia or direct nephrotoxicity. 10,11 In recent years, studies have investigated preventive therapies such as various plasma-expanding fluids, antioxidants (eg, N-acetylcysteine and ascorbic acid), diuretics, dopamine, fenoldopam, and hemofiltration, with mixed results. [12][13][14][15][16][17][18][19][20][21] Animal models of renal failure and one randomized clinical trial suggest that hy-Author Affiliations are listed at the end of this article.

Efficacy of Sodium Bicarbonate Versus Normal Saline in the Prevention of Contrast-Induced Nephropathy Among Cardiac Patients: A Cohort Study in Saudi Arabia

“…With regard to the gender-impact, in contrast to our results, studies in the USA (14,19) and one study in Iraq (30) found that male gender was associated with a lower risk of CIN. Collectively, the discrepancies identified in the relevance of risk factors may be partially attributed to the small sample size, type of CM used, and genetic make-up of the cohort in this study.…”

“…Additionally, few studies have demonstrated that abnormal baseline values of SCr (20,30,31) or eGFR (8,19) are predictors of CIN. However, the findings in this study and many other trials (14,17,21,22) did not support this similar prognostic impact. In fact, an Egyptian study reported that diabetic patients with normal baseline SCr were at an increased risk of developing CIN (31).…”

“…With regard to the absolute effectiveness of sodium bicarbonate (short-term protocol), our study revealed its inadequacy in protecting the kidney from CIN, with a high global incidence of 38 % among the high-risk group (based on renal indexes) of patients undergoing cardiac angiography. In agreement, previous randomized clinical trials (14,20,22), prospective (21), and retrospective (17) cohort studies that implemented similar bicarbonate prophylaxis guidelines, this study demonstrated significant incidence rates of CIN but with a variable range (5 % to 51.5 %). In contrast, a randomized study (13) revealed that the long-term sodium bicarbonate regimen (6 hrs before and after CM injection) was a more effective strategy to prevent CIN than the short regimen, which was employed in our cohort and all other studies.…”

“…Furthermore, closer inspection indicated further worsening of the kidney function parameters in the sodium bicarbonate intervention group compared to those in their counterparts in the saline treatment group. Similar to our study, previous trials demonstrated the nonsuperiority of sodium bicarbonate compared to standard hydration with normal saline in patients with moderate to severe CKD who were undergoing coronary angiography (14,17,18,(20)(21)(22). The previous trials included a prospective randomized trial comparing sodium bicarbonate to isotonic saline with NAC in patients undergoing coronary angiography with creatinine clearance (CrCl) <60 ml/min (18).…”

Sodium Bicarbonate versus Sodium Chloride and Oral N‐Acetylcysteine for the Prevention of Contrast‐Induced Nephropathy in Advanced Chronic Kidney Disease

“…Since all patients we studied suffered from CKD and approximately half of them had diabetes, use of iso‐osmolar contrast medium in this group may be preferable. Two recent large prospective studies in patients with eGFR <60 mL/min demonstrated, similarly to our study, about a 10% to 13% risk for CI‐AKI in patients treated with sodium bicarbonate plus NAC or isotonic saline plus NAC 21–22 . Conversely, a large retrospective study demonstrated increased risk of CI‐AKI in patients pretreated with bicarbonate 3 …”