Ajay K. Singh, MBBS, FRCP (UK); Jameela A. Kari, MD, FRCP (UK)
Is volume supplementation using 24-hour sodium chloride better than 7-hour sodium bicarbonate for preventing contrast-induced nephropathy (CIN)? Is short-term sodium bicarbonate noninferior to 7-hour sodium bicarbonate?
Randomized controlled trial. ClinicalTrials.gov NCT00130598.
Unclear allocation concealment.*
48 hours and 90 days.
3 centers in Switzerland and Italy.
273 patients ≥ 18 years of age (median age 77 y, 64% men, mean estimated glomerular filtration rate [eGFR] 44 mL/min/1.73 m2 in 258 patients who received treatment) who were admitted with renal dysfunction (eGFR < 60 mL/min/1.73 m2 or serum creatinine level > 93 µmol/L in women and > 117 µmol/L in men) and scheduled to have an intraarterial or IV radiographic contrast procedure the following day. Exclusion criteria included dialysis, severe heart failure, need for continuous fluid therapy, and N-acetylcysteine ≤ 24 hours before contrast administration.
IV sodium chloride, 0.9% given at 1 mL/kg/h for 12 hours before and 12 hours after the procedure (n = 93); IV sodium bicarbonate, 166 mEq/L given at 3 mL/kg/h for 1 hour before and 1 mL/kg/h during and for 6 hours after the procedure (n = 93); or IV sodium bicarbonate, 166 mEq/L given in a-3 mL/kg bolus (maximum 300 mL) over 20 minutes before the procedure plus oral sodium bicarbonate, 500 mg/10 kg (n = 87).
Maximum change in eGFR at 48 hours. Other outcomes included CIN (≥ 25% increase in serum creatinine level at 48 h), renal replacement therapy at 90 days, and mortality at 90 days.
93% at 90 days (intention-to-treat analysis).
The maximum increase in eGFR at 48 hours was higher and the risk for CIN was lower with 24-hour sodium chloride than with 7-hour sodium bicarbonate (Table). Short-term sodium bicarbonate was noninferior to 7-hour sodium bicarbonate for change in eGFR at 48 hours; groups did not differ for CIN (Table). The 3 groups also did not differ for mortality or renal replacement therapy at 90 days.
Volume supplementation using 24-hour isotonic sodium chloride was better than 7-hour sodium bicarbonate for preventing contrast-induced nephropathy in patients with renal dysfunction; short-term and 7-hour sodium bicarbonate did not differ for this outcome.
24-hour sodium chloride vs 7-hour sodium bicarbonate vs short-term sodium bicarbonate in patients with renal dysfunction having a radiographic contrast procedure†
†CIN = contrast-induced nephropathy; eGFR = estimated glomerular filtration rate; NS = not significant; other abbreviations defined in Glossary. RRR, NNT, and CI calculated from event rates reported in article.
‡Meets criterion for noninferiority: threshold −10 mL/min/1.73 m2.
§≥ 25% increase in serum creatinine level at 48 hours.
Singh AK, Kari JA. 24-hour isotonic sodium choloride was better than 7-hour sodium bicarbonate for preventing CIN. Ann Intern Med. ;157:JC1–9. doi: 10.7326/0003-4819-157-2-201207170-02009
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Published: Ann Intern Med. 2012;157(2):JC1-9.
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