Question: Is sodium bicarbonate superior to sodium chloride in preventing contrast-induced nephropathy in patients with chronic kidney disease (CKD) undergoing coronary angiography?

Background: Sodium bicarbonate has been suggested as a possible strategy to prevent contrast-induced nephropathy—a condition that can lead to prolonged hospitalization, increased healthcare costs, and substantial morbidity and mortality.

Study design: Randomized, controlled, single-blind study.

Setting: Kaiser Permanente Medical Center, Los Angeles.

Synopsis: Data were collected over 12 months by selecting 353 patients with stable CKD undergoing coronary angiography who were 18 or older and had an estimated glomerular filtration rate (GFR) of 60mL/min/1.73m² or less and one or more of diabetes mellitus, congestive heart failure, hypertension, or age older than 75 years. Patients were randomized to received sodium chloride (n=178) and sodium bicarbonate (n=175) at the same rate and duration.

There was no statistical difference in the primary endpoint (p=0.82), which was a 25% or greater decrease in the GFR on days 1 through 4 after contrast exposure.

Study results were limited by several factors; most importantly, it was not a double-blinded study and was performed at a single center. Also, the sodium content of the two fluids varied; normal saline carried 154mEq and sodium bicarbonate 130mEq of sodium, respectively.

Bottom line: Hydration with sodium bicarbonate is not superior to sodium chloride in preventing contrast-induced nephropathy in patients with moderate to severe CKD undergoing coronary angiography.

Citation: JAMA. 2008;300(9):1038-1046

—Reviewed for the e-wire by Elbert Chun, MD, John Vazquez, MD, Larry Beer, MD, Maged Doss, MD, Vana Bollineni, MD, Mohammed S. Singapuri, MD, Dan Dressler, MD, MsCR, Emory University Hospital, Atlanta