Sodium bicarbonate improves long-term clinical outcomes compared with sodium chloride in patients with chronic kidney disease undergoing an emergent coronary procedure

Abstract

Background: Contrast-induced nephropathy is associated with increased in-hospital and long-term adverse clinical outcomes. Methods and Results: To 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 3ml·kg -1·h-1 for 1 h before the administration of contrast, followed by an infusion of 1ml·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.