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Sodium Bicarbonate Hydration Significantly Reduces Contrast-Induced Nephropathy After Radiographic Contrast

Contrast-induced nephropathy developed significantly less often in patients hydrated with sodium bicarbonate than in those hydrated with sodium chloride before and after radiographic contrast.

From September 16, 2002 through June 17, 2003, Thomas P. Kennedy, MD, MPH, Department of Internal Medicine, Carolinas Medical Center, Charlotte, North Carolina, United States, and colleagues assessed contrast-induced nephropathy in 119 patients treated with 154 mEq/L of sodium bicarbonate or sodium chloride prior to iopamidol contrast for an interventional or diagnostic procedure.

The 60 patients treated with sodium bicarbonate did not significantly differ from the 59 patients treated with sodium chloride in age, sex ethnicity, incidence of diabetes mellitus, weight, or by mean volume of contrast administered or in volumes of contrast received.

"Despite a higher mean baseline serum creatinine and a higher number of individuals with a baseline creatinine level of at least 2.5 mg/dL," the authors write, "the group receiving sodium bicarbonate treatment incurred only a 1.7% (1 of 60) incidence of contrast-induced nephropathy compared with 13.6% (8 of 59) in patients who received sodium chloride."

A post hoc analysis revealed a +8.5% change in glomerular filtration rate after contrast in patients treated with sodium bicarbonate compared with -0.1% for patients treated with sodium chloride. Also, 11.9% of the patients in the sodium bicarbonate group, compared with 1.7% of those in the sodium chloride group, had at least 0.5 mg/dL change in serum creatinine.

The study was halted after a review by the safety monitor due to ethical concerns of the continued higher risk of contrast nephropathy among patients treated with sodium chloride. All subsequent patients meeting inclusion criteria received sodium bicarbonate. Analysis of the registry of these 191 patients revealed that contrast-induced nephropathy occurred in 1.6%.

"We showed that replacing chloride ion with bicarbonate as the anion in sodium-containing hydration fluids significantly reduced nephropathy following radiographic contrast injection," the authors conclude. "Although confirmation in a larger multi-institution study would be appropriate, infusion of sodium bicarbonate may provide an inexpensive, safe, practical, and simple method for preventing contrast-induced renal failure," they suggest.

JAMA 2004;291:2328-2334

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