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Pre-Cath Sodium Bicarbonate Hydration Limits Contrast Nephropathy

Another option for preventing contrast-induced nephropathy

Upon undergoing cardiovascular procedures that require radiocontrast administration, many patients -- including about half of those with renal insufficiency and diabetes -- experience contrast-induced nephropathy. As prevention, current protocols recommend pre- and postprocedural sodium chloride hydration. Investigators hypothesized that hydration with sodium bicarbonate would limit free-radical formation and kidney injury and, therefore, be superior to sodium chloride in this context.

In a single-center, randomized trial, the investigators enrolled patients with baseline serum creatinine levels >1.1 mg/dL who were scheduled to undergo radiocontrast-requiring procedures. (Cardiac catheterization was the procedure in 97 of the 119 patients included in the final analysis.) Patients received either sodium chloride or sodium bicarbonate, both as 154-mEq/L infusions (3 mL/kg during the hour before contrast administration, and 1 mL/kg during and for 6 hours after the procedure).

The trial was halted early because contrast-induced nephropathy, defined as a 25% increase in serum creatinine within 2 days of contrast administration, occurred significantly more often with sodium chloride than with sodium bicarbonate (8 events vs. 1 event). The mean contrast volume used for the cardiac catheterizations was about 134 mL.

Comment: An editorialist recommends sodium bicarbonate hydration as "the treatment of choice" for preventing contrast-induced nephropathy. Recent research has also documented the benefits of iso-osmolar contrast, N-acetylcysteine, and hemofiltration -- we don't yet know which approach is best in which patients. Still, physicians should consider noncontrast imaging procedures when feasible, limit dye load in any contrast-requiring procedure, and always ensure adequate preprocedural hydration.

— JoAnne M. Foody, MD

Published in Journal Watch Cardiology June 25, 2004

Citation(s):

Merten GJ et al. Prevention of contrast-induced nephropathy with sodium bicarbonate: A randomized controlled trial. JAMA 2004 May 19; 291:2328-34.

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• Medline abstract (Free)

Chertow GM. Prevention of radiocontrast nephropathy: Back to basics. JAMA 2004 May 19; 291:2376-7.

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• Medline abstract (Free)