Sodium bicarbonate versus isotonic saline for the prevention of contrast induced nephropathy in patients with diabetes mellitus undergoing coronary angiography and/or intervention: a multicenter study

Abstract

Objectives: Contrast induced nephropathy (CIN) is a leading cause of acute renal failure and affects mortality and morbidity. Although CIN incidence is quite low in the general population, the incidence of CIN is significantly increased in diabetes mellitus (DM). We compared the efficacy of prophylactic use consisting of a saline infusion or a sodium bicarbonate infusion for the prevention of CIN in patients with DM. Methods: A total of 195 DM patients, who had unselected renal function, were randomized into 2 groups: 101 patients were assigned to saline infusion and 94 patients were assigned patients to bicarbonate infusion. The primary end point was the maximum increase in the serum creatinine (SCr) level. The secondary end point was the development of CIN after the procedure. Results: The maximum increase in SCr levels was significantly lower in the saline group than in the bicarbonate group, -0.03 [IQR = -0.09 to 0.10] mg/dL vs. 0.02 [IQR = -0.09 to 0.13] mg/dL (P=0.014) (Figure). The rate of CIN was significantly lower in the saline group than in the bicarbonate group (5.9% vs. 16%, P=0.024). In the subset of study participants with a baseline creatinine clearance of <60 mL/min, the maximum increase in SCr levels was significantly lower -0.08 [IQR = -0.13 to -0.04] mg/dL in the saline group than in the bicarbonate group 0.03 [IQR = -0.13 to 0.12] mg/dL (P=0.004). ![Figure][1] Figure 1 Conclusions: The use of prophylactic hydration with isotonic saline before coronary procedures may decrease SCr levels and reduce the incidence of CIN in DM patients with unselected renal functions to a greater extent than sodium bicarbonate [1]: pending:yes