Evaluation of different sodium bicarbonate regimens for the prevention of
contrast medium-induced nephropathy
#MMPMID27054007
Abouzeid S
; Mosbah O
Electron Physician
2016[Feb]; 8
(2
): 1973-7
PMID27054007
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INTRODUCTION: The rapid decline in renal function caused by radiographic contrast
agents usually is transient, but it can result in chronic kidney disease. The
pathophysiology of contrast-induced nephropathy (CIN) is poorly understood, but
it may include acute hypoxia-induced oxidative stress and free radicals generated
within the acid environment of the renal medulla. Thus, the alkalization of urine
by sodium bicarbonate has been regarded as resulting in the reduction of CIN. The
aim of this study was to determine whether a long-duration sodium bicarbonate
regimen is more effective than a short-duration regimen in reducing CIN. METHODS:
One hundred patients were assigned randomly to treatment with sodium bicarbonate
solution using either the short regimen (intravenous bolus 3 mL/kg/h of 166 mEq/L
sodium bicarbonate for 1 hour immediately before radiocontrast) or the long
regimen (initial intravenous bolus of 3 mL/kg/h of 166 mEq/L sodium bicarbonate
for 6 hr). Patients with renal dysfunction (estimated glomerular filtration rate
[eGFR], 60 mL/min/1.73 m(2) or less) who underwent elective or emergent coronary
angiography (CAG) with/without percutaneous coronary intervention (PCI) at
Nephrology Department (Theodor Bilharz Research Institute) were enrolled in the
study. Data were analyzed by SPSS version 12, using Kruskal Wallis, ANOVA, Chi
square test and Spearman rank correlation coefficient. RESULTS: There was a
significant increase in serum creatinine and a decrease in eGFR 48 hr
post-intervention in group 1 (short regimen) with no statically difference
regarding those parameters group 2 (long regimen). Serum potassium clearly was
decreased significantly post procedure in both groups. CONCLUSIONS: The results
of our study indicated that the long regimen of bicarbonate supplementation was a
more effective strategy to prevent CIN than the short regimen.
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