Prevention of Contrast-Induced Nephropathy by Bolus Injection of Sodium Bicarbonate in Patients With Chronic Kidney Disease Undergoing Emergent Coronary Procedures

Guidelines on the use of iodinated contrast media in patients with kidney disease 2012: digest version

“…There are 3 reports on sodium bicarbonate-based hydration in Japan. Ueda et al [118] compared bolus saline infusion with bolus sodium bicarbonate infusion immediately before emergency PCI, and reported that sodium bicarbonate infusion significantly decreased the incidence of CIN by 88 % (RR: 0.128, 95 % CI: 0.016 * 0.91, p = 0.01). In a RCT of 144 patients with mild CKD undergoing an elective CAG, Tamura et al [119] reported that the incidence of CIN was lower in patients receiving standard saline hydration (12 h before contrast exposure) plus a single-bolus intravenous administration of 20 mEq/L sodium bicarbonate (MEY-LON Ò 20 mL) immediately before contrast exposure than in patients receiving standard saline hydration alone (p = 0.017).…”

“…These 7 studies differ in design, and sodium bicarbonate-based hydration was concluded to be effective in 3 studies [118][119][120] and ineffective in 4 studies [121][122][123][124]. The 4 studies that concluded that the sodium bicarbonate-based hydration was ineffective included 2 studies conducted in the same institution around the same time.…”

Preventing radiocontrast-induced nephropathy in chronic kidney disease patients undergoing coronary angiography

“…Since the first publication of this initial study by Merten et al [149] , many trials evaluating IV sodium bicarbonate for the prevention of RCIN have been performed and published in the literature, but yielded highly conflicting results [53,[150][151][152][153][154][155][156][157][158] . Over the past 8 years, at least 12 clinical trials comparing the development of RCIN following the administration of either isotonic bicarbonate or isotonic saline have been published in the peer-reviewed literature; eight demonstrating a lower incidence of RCIN with bicarbonate administration [108,[149][150][151][152][153][154][155] , and four showing no significant benefit [53,[156][157][158] .…”

“…The clinical trials showing benefit of bicarbonate over saline for RCIN are shown in Table 6. In the most recently published study by Ueda et al [155] , 59 patients with mild CKD were scheduled at admission to undergo an emergency coronary procedure. The patients were randomized to receive a bolus IV injection of 154 mEq/L sodium bicarbonate (n = 30) or sodium chloride (n = 29) at a dose of 0.5 mL/kg, before contrast administration, followed by infusion of 154 mEq/L sodium bicarbonate at 1 mL/kg per hour for 6 h in both groups.…”

“…Over the past 8 years, at least 12 clinical trials comparing the development of RCIN following the administration of either isotonic bicarbonate or isotonic saline have been published in the peer-reviewed literature; eight demonstrating a lower incidence of RCIN with bicarbonate administration [108,[149][150][151][152][153][154][155] , and four showing no significant benefit [53,[156][157][158] . The clinical trials showing benefit of bicarbonate over saline for RCIN are shown in Table 6.…”