24-hour isotonic sodium choloride was better than 7-hour sodium bicarbonate for preventing CIN

Abstract

Questions: Is volume supplementation using 24-hour sodium chloride better than 7-hour sodium bicarbonate for preventing contrast-induced nephropathy (CIN)? Is short-term sodium bicarbonate noninferior to 7-hour sodium bicarbonate? Methods Design: Randomized controlled trial. ClinicalTrials.gov NCT00130598. Allocation: Unclear allocation concealment.* Blinding: Unblinded.* Follow-up period: 48 hours and 90 days. Setting: 3 centers in Switzerland and Italy. Patients: 273 patients ≥ 18 years of age (median age 77 y, 64% men, mean estimated glomerular filtration rate [eGFR] 44 mL/min/1.73 m2 in 258 patients who received treatment) who were admitted with renal dysfunction (eGFR < 60 mL/min/1.73 m2 or serum creatinine level > 93 μmol/L in women and > 117 μmol/L in men) and scheduled to have an intraarterial or IV radiographic contrast procedure the following day. Exclusion criteria included dialysis, severe heart failure, need for continuous fluid therapy, and N-acetylcysteine ≤ 24 hours before contrast administration. Interventions: IV sodium chloride, 0.9% given at 1 mL/kg/h for 12 hours before and 12 hours after the procedure (n = 93); IV sodium bicarbonate, 166 mEq/L given at 3 mL/kg/h for 1 hour before and 1 mL/kg/h during and for 6 hours after the procedure (n = 93); or IV sodium bicarbonate, 166 mEq/L given in a-3 mL/kg bolus (maximum 300 mL) over 20 minutes before the procedure plus oral sodium bicarbonate, 500 mg/10 kg (n = 87). Outcomes: Maximum change in eGFR at 48 hours. Other outcomes included CIN (≥ 25% increase in serum creatinine level at 48 h), renal replacement therapy at 90 days, and mortality at 90 days. Patient follow-up: 93% at 90 days (intention-to-treat analysis). Main results: The maximum increase in eGFR at 48 hours was higher and the risk for CIN was lower with 24-hour sodium chloride than with 7-hour sodium bicarbonate (Table). Short-term sodium bicarbonate was noninferior to 7-hour sodium bicarbonate for change in eGFR at 48 hours; groups did not differ for CIN (Table). The 3 groups also did not differ for mortality or renal replacement therapy at 90 days. Conclusion: Volume supplementation using 24-hour isotonic sodium chloride was better than 7-hour sodium bicarbonate for preventing contrast-induced nephropathy in patients with renal dysfunction; short-term and 7-hour sodium bicarbonate did not differ for this outcome. © 2012 American College of Physicians.