A comparison of sodium bicarbonate infusion versus normal saline infusion and its combination with oral acetazolamide for prevention of contrast-induced nephropathy: a randomized, double-blind trial

Pakfetrat, Maryam; Nikoo, Mohammad Hossein; Malekmakan, Leila; Tabandeh, Mahmoud; Roozbeh, Jamshid; Nasab, Mahshid Hashemi; Ostovan, Mohammad Ali; Salari, Soheila; Kafi, Mohammad Abdullah Heel; Vaziri, Najmeh Moin; Adl, Farzad Hami; Hosseini, Mahdi; Khajehdehi, Parviz

doi:10.1007/s11255-008-9520-y

Cited by 59 publications

(32 citation statements)

References 33 publications

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“…Recent studies focused on the comparative effectiveness of IV sodium bicarbonate (bicarbonate) and IV sodium chloride (saline) based on the hypothesis that alkalinization of tubular fluid with bicarbonate will decrease the generation of injurious reactive oxygen species. Several trials suggested bicarbonate to be more effective than saline (5)(6)(7)(8)(9)(10)(11)(12), whereas others reported no difference (13)(14)(15)(16)(17)(18)(19)(20)(21). A second preventive intervention that has received substantial attention is the administration of N-acetylcysteine (NAC), an antioxidant with vasodilatory properties.…”

Section: Introductionmentioning

confidence: 99%

Prevention of Contrast-Induced AKI

Weisbord¹,

Gallagher²,

Kaufman³

et al. 2013

Clinical Journal of the American Society of Nephrology

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SummaryContrast-induced AKI (CI-AKI) is a common condition associated with serious, adverse outcomes. CI-AKI may be preventable because its risk factors are well characterized and the timing of renal insult is commonly known in advance. Intravenous (IV) fluids and N-acetylcysteine (NAC) are two of the most widely studied preventive measures for CI-AKI. Despite a multitude of clinical trials and meta-analyses, the most effective type of IV fluid (sodium bicarbonate versus sodium chloride) and the benefit of NAC remain unclear. Careful review of published trials of these interventions reveals design limitations that contributed to their inconclusive findings. Such design limitations include the enrollment of small numbers of patients, increasing the risk for type I and type II statistical errors; the use of surrogate primary endpoints defined by small increments in serum creatinine, which are associated with, but not necessarily causally related to serious, adverse, patient-centered outcomes; and the inclusion of low-risk patients with intact baseline kidney function, yielding low event rates and reduced generalizability to a higher-risk population. The Prevention of Serious Adverse Events following Angiography (PRESERVE) trial is a randomized, double-blind, multicenter trial that will enroll 8680 high-risk patients undergoing coronary or noncoronary angiography to compare the effectiveness of IV isotonic sodium bicarbonate versus IV isotonic sodium chloride and oral NAC versus oral placebo for the prevention of serious, adverse outcomes associated with CI-AKI. This article discusses key methodological issues of past trials investigating IV fluids and NAC and how they informed the design of the PRESERVE trial.

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Section: Introductionmentioning

confidence: 99%

Prevention of Contrast-Induced AKI

Weisbord¹,

Gallagher²,

Kaufman³

et al. 2013

Clinical Journal of the American Society of Nephrology

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“…(37) Two subsequent RCTs by Recio-Mayoral et al in 2007 and Pakfetrat et al in 2009 compared the effect of a single bolus of NaHCO 3 before coronary angiography or PCI; both studies showed a significant reduction of CIN in the group treated with the NaHCO 3 bolus. (38,39) One meta-analysis involving a total of 1,734 patients showed that NaHCO 3 is superior to NaCl alone in the prevention of CIN in patients with moderate to severe CKD. (40) However, a study of 353 patients undergoing coronary angiography (MEENA trial) showed no benefit of sodium bicarbonate over normal saline in preventing CIN.…”

Section: 9% Of Normal Salinementioning

confidence: 99%

Renal-related adverse effects of intravenous contrast media in computed tomography

Leow¹,

Wu²,

Tan³

2015

smedj

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Renal-related adverse effects of intravascular contrast media (CM) include contrast-induced nephropathy in computed tomography and angiography. While large retrospective studies have been published, the exact pathogenesis of this condition is still unknown. We review the main international guidelines, including the American College of Radiology white paper and the guidelines of European Society of Urogenital Radiology, Royal College of Radiologists and Canadian Association of Radiologists, as well as their references, regarding this subject. We present a simplified, concise approach to renal-related adverse effects of CM, taking into consideration the basis for each recommendation in these published guidelines. This will allow the reader to better understand the rationale behind appropriate patient preparation for crosssectional imaging.

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“…21, 25 Eleven authors used a combination of a 0.5 mg/dl absolute creatinine increase or a relative increase of 25%. 12-17,20,26-29 One study regarded an absolute increase of creatinine of 1.5 mg/dl or 25% relative decrease of estimated glomerular filtration rate (eGFR) 30 and Brar et al 31 used a change in GFR as the primary endpoint and a change in creatinine as a secondary definition of CI-AKI.…”

Section: Data Extraction and Quality Assessmentmentioning

confidence: 99%

Sodium Bicarbonate Therapy for the Prevention of Contrast-Induced Acute Kidney Injury

Jang

Jin

Seo

et al. 2012

Circ J

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A comparison of sodium bicarbonate infusion versus normal saline infusion and its combination with oral acetazolamide for prevention of contrast-induced nephropathy: a randomized, double-blind trial

Abstract: It seems that both Bi and AZ reduce the risk of CIN-related AKI, and close monitoring of serum potassium is needed during bicarbonate infusion.

Cited by 59 publications

References 33 publications

Prevention of Contrast-Induced AKI

Prevention of Contrast-Induced AKI

Renal-related adverse effects of intravenous contrast media in computed tomography

Sodium Bicarbonate Therapy for the Prevention of Contrast-Induced Acute Kidney Injury

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