Prevention Of Contrast-induced Nephropathy With Sodium Bicarbonate

Objective:To observe the incidence of contrast-induced nephropathy (CIN) in patients with coronary heart disease after coronary angiography/ intervention and to compare the efficacy of sodium bicarbonate versus sodium chloride to prevent CIN.Method:210 patients undergoing elective coronary angiography or intervention enrolled in this study were assigned into two groups:the sodium bicarbonate (the treated group, n=110) and the sodium chloride (the control group, n= 100) before using contrast medium. The primary end point was an absolute≥0.5mg/dL(44.2μmol/L)or relative (≥25%) increase in serum creatinine 48 hours after iopamiro 370 exposure.An infusion was performed at rate 3ml/(kg·h) for 1 hours before coronary angiography, followed by an infusion of 1ml/kg-h for 6 hours in surgery and after coronary angiography/ intervention. Serum creatinine level, bicarbonate values and urine pH were measured at baseline before using contrast medium and 24 hour,48 hour after using contrast medium. The incidence of CIN was compared between the two groups.Results:The groups were well matched for baseline characteristics. Median patient age was 60 (interquartile range,33-83) years, The weighted mean baseline creatinine of the overall population was (94.8±20.2)μmol/L. No significant difference in the the average amount of contrast medium and liquid infusion between the two goups. There were 17 cases of CIN in the two goups. The morbidity of CIN was 12.0 %(12/100) in sodium chloride group while 4.5%(5/110) in sodium bicarbonate group. There was a significant difference in the incidence of CIN between the two groups (P=0.04).Conclusions:Hydration with sodium bicarbonate before contrast medium exposure is more effective than hydration with sodium chloride in the prevention of CIN.