Sodium Bicarbonate Improves Long-Term Clinical Outcomes Compared With Sodium Chloride in Patients With Chronic Kidney Disease Undergoing an Emergent Coronary Procedure

Abstract

Study ProtocolEligible patients were randomly assigned to the sodium bicarbonate group or the sodium chloride group. Patients allocated to the 2 groups received 154 mmol/L of either sodium bicarbonate or sodium chloride. As soon as possible after admission, the following hydration protocol was started. The initial intravenous bolus was 3 ml·kg -1 ·h -1 for 1 h, if possible, before the coronary procedure. Patients subsequently received the same fluid at a rate of 1 ml·kg -1 ·h -1 J 2008; 72: 1610 -1614 (Received April 15, 2008 revised manuscript received May 26, 2008; accepted June 3, 2008; released online August 29, 2008 Background Contrast-induced nephropathy is associated with increased in-hospital and long-term adverse clinical outcomes. Circ Methods and ResultsTo investigate whether hydration with sodium bicarbonate improves long-term clinical outcomes compared with sodium chloride, patients with chronic kidney disease undergoing an emergent coronary procedure were enrolled in a randomized clinical trial with ≥1 year of follow-up. The 59 patients with chronic kidney disease (serum creatinine concentration >1.1 mg/dl or estimated glomerular filtration rate <60 ml/min) were randomly assigned to receive a 154 mmol/L intravenous infusion of either sodium bicarbonate (n=30) or sodium chloride (n=29). The electrolytes were given as a bolus of 3 ml·kg -1 ·h -1 for 1 h before the administration of contrast, followed by an infusion of 1 ml·kg -1 ·h -1 for 6 h during and after the procedure. During a mean follow-up period of 15.9±4.5 months, the incidence of renal replacement therapy or death was significantly lower in the sodium bicarbonate group than in the sodium chloride group (3% vs 21%, respectively; p=0.037).Conclusions Hydration with sodium bicarbonate reduces the incidence of renal replacement therapy and death in patients with chronic kidney disease undergoing an emergent coronary procedure. (Circ J 2008; 72: 1610 -1614

Prävention der kontrastmittelinduzierten Nephropathie mit isotonem Natriumbikarbonat: eine Meta-Analyse

“…In line with this scepticism a cohort analysis of over 32,000 patients recently reported a transitory 25% increase in creatinine from a normal baseline in up to 27% of hospitalized patients without their ever having received any contrast media [26]. On the other hand, a recently published follow-up study on one of the trials included in this analysis [6] reported a significantly lower incidence of mortality and requirement for renal replacement therapy in the group treated with sodium bicarbonate after an average observation period of 15 months, suggesting even a long-term benefit [27].…”

Protective Effects of Anisodamine on Renal Function in Patients with ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

“…A large number of drugs have been used to protect renal function after PCI, such as aminophylline (Shammas et al 2001;Rohani 2010), theophylline (Wang et al 2001), atrial natriuretic peptide (Chen 2009;Morikawa et al 2009), B-type natriuretic peptide (Zhang et al 2010), mannitol (Kelly et al 2008), prostaglandins (McCullough andTumlin 2009), N-acetylcysteine (Thiele et al 2010), sodium bicarbonate (Masuda 2008) and statins (Xinwei et al 2009); however, few of them (Kowalczyk et al 2007;Zoungas et al 2009) have shown exact protective effects.…”

Prediction of Chronic Renal Insufficiency After Coronary Angiography by an Early Increase in Oxidative Stress and Decrease in Glomerular Filtration Rate

“…30, 31 Masuda et al previously reported that hydration with sodium bicarbonate reduces the incidence of renal replacement therapy and death in patients with chronic kidney disease undergoing an emergent coronary procedure. 32 A possible mechanism for the prevention of CIN with sodium bicarbonate is inhibition of oxidant injury through alkalizing renal tubular fluid. In the present study, we directly demonstrated a relationship between contrast-induced oxidative stress and chronic renal insufficiency.…”