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Sodium bicarbonate not superior to chloride for prevention of contrast-induced nephropathy
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American College of Cardiology 59th Annual Scientific Sessions
ATLANTA – Sodium bicarbonate hydration may not be the most effective method to prevent contrast-induced nephropathy in patients with diabetes, new study results suggested.
"In patients with diabetic nephropathy who received coronary or endovascular angiography or intervention, hydration with sodium bicarbonate before or after contrast exposure was not superior to hydration with [saline] for the prevention of contrast-induced nephropathy," Young-Hak Kim, MD, of Asan Medical Center, Seoul, South Korea, said at a presentation on Sunday.
For the PREVENT trial, researchers randomly assigned 375 patients with diabetes and stable renal disease (serum creatinine ≥1.1 mg/dL; estimated glomerular filtration <60 mL/min/1.73 m2) to either sodium chloride or sodium bicarbonate for the prevention of contrast-induced nephropathy (defined as serum creatinine ≥0.5 mg/dL within 48 hours of exposure). Patients assigned sodium chloride were given 1 ml/kg per hour for 12 hours before and 12 hours after the procedure; those assigned sodium bicarbonate were given 3 ml/kg per hour for one hour before iso-osmolar contract injection, followed by 1 mg/kg per hour during the procedure and for six hours after completion. Patients also received 1,200 mg N-acetylcysteine twice per day.
The rate of contrast-induced nephropathy did not significantly differ between the two groups. Contrast-induced nephropathy occurred in seven patients (5.3%) assigned to sodium chloride and 16 (9%) assigned to sodium bicarbonate. Furthermore, several renal dysfunction patients (baseline creatinine >2 mg/dL and estimated glomerular filtration <40 mL/min/1.73m2) also had similar findings (13% in saline group vs. 20% in sodium bicarbonate; P=.034), according to Kim. Multivariate analysis showed that predictors of contrast-induced nephropathy was baseline renal function (OR=5.85), contrast volume (OR=1.01) and left ventricular function (OR=0.96). Four patients (2.1%) assigned to sodium bicarbonate and two (1.1%) assigned to sodium chloride required hemodialysis.
"The bicarbonate therapy is no longer effective in renal protection from contrast," Seung-Whan Lee, MD, PhD, also of Asan Medical Center, said in a press release. "Based on our data, use of minimal contrast volume and adequate hydration are the best strategy to prevent contrast-induced nephropathy in patients with diabetes.Other efforts should be taken to reduce contrast-induced nephropathy in diabetic patients." - by Matthew Brannon
For more information:
- Lee SW. ACC/i2 Featured Clinical Research. Presented at: American College of Cardiology 59th Annual Scientific Sessions; March 13-16, 2010; Atlanta.
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