Sodium Bicarbonate is Associated with an Increased Incidence of Contrast Nephropathy

Abstract

Results: A total of 11,516 contrast exposures in 7977 patients had creatinine values available for review before and after contrast exposure. More than 90% of exposures to agents prophylactic for contrast nephropathy were available for analysis. Sodium bicarbonate was used in 268 cases, N-acetylcysteine was used in 616 cases, and both agents were used in combination in 221 cases of contrast exposure. After adjustment for total volume of hydration, medications, age, gender, prior creatinine, contrast iodine load, prior exposure to contrast material, type of imaging study, heart failure, hypertension, renal failure, multiple myeloma, and diabetes mellitus, use of sodium bicarbonate alone was associated with an increased risk of contrast nephropathy compared with no treatment (odds ratio 3.10, 95% confidence interval 2.28 to 4.18; P < 0.001). N-acetylcysteine alone and in combination with sodium bicarbonate was not associated with any significant difference in the incidence of contrast nephropathy.Conclusions: The use of intravenous sodium bicarbonate was associated with increased incidence of contrast nephropathy. Use of sodium bicarbonate to prevent contrast nephropathy should be evaluated further rather than adopted into clinical practice.

Prevenção de nefrotoxicidade por contraste com solução de bicarbonato: resultados preliminares e revisão da literatura

“…59 In that study, patients receiving sodium bicarbonate had a greater prevalence of nephrotoxicity in comparison with those receiving no treatment and those treated with bicarbonate associated with N-acetyl cysteine. Despite the large number of patients studied (almost 8,000), the study is retrospective, and there was obviously no previous criterion of inclusion or randomization for the groups.…”

“…However, the retrospective characteristic of the study did not allow adequate stratification of risk factors, and, thus, those results should be interpreted cautiously. 59 Joannidis et al have analyzed nine randomized clinical trials comparing the use of bicarbonate for preventing CN in 2,043 patients. The OR was 0.45 (95% CI: 0.26-0.79), indicating a beneficial effect of the treatment with bicarbonate as compared with the treatment with saline.…”

Evidence‐based approach for prevention of radiocontrast‐induced nephropathy

“…48 However, multiple weaknesses associated with the retrospective study design, such as inclusion of few patients at high CN risk, and acceptance of serum creatinine values within 7 days before and after the contrast procedure, which likely captures causes of acute kidney injury other than CN, preclude abandonment of NaHCO 3 prophylaxis for CN solely on the basis of this study.…”

Sodium bicarbonate infusion for prevention of acute kidney injury: No evidence for superior benefit, but risk for harm?

“…Retrospective cohort analyses suggested that intravenous sodium bicarbonate was associated with an increased risk of CIN [43] or pigment nephropathy [44,45]. The multicenter trial of prophylactic perioperative sodium bicarbonate administration to prevent AKI following open heart surgery found a non-significant increase in AKI and a possible increase in in-hospital mortality [37].…”