Sodium chloride vs. sodium bicarbonate for the prevention of contrast medium-induced nephropathy

A randomized controlled trial

Theresia Klima, Andreas Christ, Ivana Marana, Stefan Kalbermatter, Heiko Uthoff, Emanuel Burri, Sabine Hartwiger, Christian Schindler, Tobias Breidthardt, Giancarlo Marenzi, Christian Mueller

Research output: Contribution to journalArticle

58 Citations (Scopus)

Abstract

AimsThe most effective regimen for the prevention of contrast-induced nephropathy (CIN) remains uncertain. Our purpose was to compare two regimens of sodium bicarbonate with 24 h sodium chloride 0.9 infusion in the prevention of CIN. Methods and resultsWe performed a prospective, randomized trial between March 2005 and December 2009, including 258 consecutive patients with renal insufficiency undergoing intravascular contrast procedures. Patients were randomized to receive intravenous volume supplementation with either (A) sodium chloride 0.9 1 mL/kg/h for at least 12h prior and after the procedure or (B) sodium bicarbonate (166 mEq/L) 3 mL/kg for 1h before and 1 mL/kg/h for 6h after the procedure or (C) sodium bicarbonate (166 mEq/L) 3 mL/kg over 20min before the procedure plus sodium bicarbonate orally (500 mg per 10 kg). The primary endpoint was the change in estimated glomerular filtration rate (eGFR) within 48h after contrast. Secondary endpoints included the development of CIN. The maximum change in eGFR was significantly greater in Group B compared with Group A mean difference -3.9 [95 confidence interval (CI), -6.8 to -1] mL/min/1.73 m2, P = 0.009 and similar between Groups C and B [mean difference 1.3 (95 CI, -1.74.3) mL/min/1.73 m2, P = 0.39]. The incidence of CIN was significantly lower in Group A (1) vs. Group B (9, P = 0.02) and similar between Groups B and C (10, P = 0.9). ConclusionVolume supplementation with 24 h sodium chloride 0.9 is superior to sodium bicarbonate for the prevention of CIN. A short-term regimen with sodium bicarbonate is non-inferior to a 7 h regimen.

Original languageEnglish
Pages (from-to)2071-2079
Number of pages9
JournalEuropean Heart Journal
Volume33
Issue number16
DOIs
Publication statusPublished - Aug 2012

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Sodium Bicarbonate
Sodium Chloride
Contrast Media
Randomized Controlled Trials
Glomerular Filtration Rate
Confidence Intervals
Endovascular Procedures
Renal Insufficiency
Incidence

Keywords

  • Contrast-induced nephropathy
  • Prevention
  • Sodium bicarbonate
  • Sodium chloride

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Sodium chloride vs. sodium bicarbonate for the prevention of contrast medium-induced nephropathy : A randomized controlled trial. / Klima, Theresia; Christ, Andreas; Marana, Ivana; Kalbermatter, Stefan; Uthoff, Heiko; Burri, Emanuel; Hartwiger, Sabine; Schindler, Christian; Breidthardt, Tobias; Marenzi, Giancarlo; Mueller, Christian.

In: European Heart Journal, Vol. 33, No. 16, 08.2012, p. 2071-2079.

Research output: Contribution to journalArticle

Klima, T, Christ, A, Marana, I, Kalbermatter, S, Uthoff, H, Burri, E, Hartwiger, S, Schindler, C, Breidthardt, T, Marenzi, G & Mueller, C 2012, 'Sodium chloride vs. sodium bicarbonate for the prevention of contrast medium-induced nephropathy: A randomized controlled trial', European Heart Journal, vol. 33, no. 16, pp. 2071-2079. https://doi.org/10.1093/eurheartj/ehr501
Klima, Theresia ; Christ, Andreas ; Marana, Ivana ; Kalbermatter, Stefan ; Uthoff, Heiko ; Burri, Emanuel ; Hartwiger, Sabine ; Schindler, Christian ; Breidthardt, Tobias ; Marenzi, Giancarlo ; Mueller, Christian. / Sodium chloride vs. sodium bicarbonate for the prevention of contrast medium-induced nephropathy : A randomized controlled trial. In: European Heart Journal. 2012 ; Vol. 33, No. 16. pp. 2071-2079.
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abstract = "AimsThe most effective regimen for the prevention of contrast-induced nephropathy (CIN) remains uncertain. Our purpose was to compare two regimens of sodium bicarbonate with 24 h sodium chloride 0.9 infusion in the prevention of CIN. Methods and resultsWe performed a prospective, randomized trial between March 2005 and December 2009, including 258 consecutive patients with renal insufficiency undergoing intravascular contrast procedures. Patients were randomized to receive intravenous volume supplementation with either (A) sodium chloride 0.9 1 mL/kg/h for at least 12h prior and after the procedure or (B) sodium bicarbonate (166 mEq/L) 3 mL/kg for 1h before and 1 mL/kg/h for 6h after the procedure or (C) sodium bicarbonate (166 mEq/L) 3 mL/kg over 20min before the procedure plus sodium bicarbonate orally (500 mg per 10 kg). The primary endpoint was the change in estimated glomerular filtration rate (eGFR) within 48h after contrast. Secondary endpoints included the development of CIN. The maximum change in eGFR was significantly greater in Group B compared with Group A mean difference -3.9 [95 confidence interval (CI), -6.8 to -1] mL/min/1.73 m2, P = 0.009 and similar between Groups C and B [mean difference 1.3 (95 CI, -1.74.3) mL/min/1.73 m2, P = 0.39]. The incidence of CIN was significantly lower in Group A (1) vs. Group B (9, P = 0.02) and similar between Groups B and C (10, P = 0.9). ConclusionVolume supplementation with 24 h sodium chloride 0.9 is superior to sodium bicarbonate for the prevention of CIN. A short-term regimen with sodium bicarbonate is non-inferior to a 7 h regimen.",
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AU - Klima, Theresia

AU - Christ, Andreas

AU - Marana, Ivana

AU - Kalbermatter, Stefan

AU - Uthoff, Heiko

AU - Burri, Emanuel

AU - Hartwiger, Sabine

AU - Schindler, Christian

AU - Breidthardt, Tobias

AU - Marenzi, Giancarlo

AU - Mueller, Christian

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N2 - AimsThe most effective regimen for the prevention of contrast-induced nephropathy (CIN) remains uncertain. Our purpose was to compare two regimens of sodium bicarbonate with 24 h sodium chloride 0.9 infusion in the prevention of CIN. Methods and resultsWe performed a prospective, randomized trial between March 2005 and December 2009, including 258 consecutive patients with renal insufficiency undergoing intravascular contrast procedures. Patients were randomized to receive intravenous volume supplementation with either (A) sodium chloride 0.9 1 mL/kg/h for at least 12h prior and after the procedure or (B) sodium bicarbonate (166 mEq/L) 3 mL/kg for 1h before and 1 mL/kg/h for 6h after the procedure or (C) sodium bicarbonate (166 mEq/L) 3 mL/kg over 20min before the procedure plus sodium bicarbonate orally (500 mg per 10 kg). The primary endpoint was the change in estimated glomerular filtration rate (eGFR) within 48h after contrast. Secondary endpoints included the development of CIN. The maximum change in eGFR was significantly greater in Group B compared with Group A mean difference -3.9 [95 confidence interval (CI), -6.8 to -1] mL/min/1.73 m2, P = 0.009 and similar between Groups C and B [mean difference 1.3 (95 CI, -1.74.3) mL/min/1.73 m2, P = 0.39]. The incidence of CIN was significantly lower in Group A (1) vs. Group B (9, P = 0.02) and similar between Groups B and C (10, P = 0.9). ConclusionVolume supplementation with 24 h sodium chloride 0.9 is superior to sodium bicarbonate for the prevention of CIN. A short-term regimen with sodium bicarbonate is non-inferior to a 7 h regimen.

AB - AimsThe most effective regimen for the prevention of contrast-induced nephropathy (CIN) remains uncertain. Our purpose was to compare two regimens of sodium bicarbonate with 24 h sodium chloride 0.9 infusion in the prevention of CIN. Methods and resultsWe performed a prospective, randomized trial between March 2005 and December 2009, including 258 consecutive patients with renal insufficiency undergoing intravascular contrast procedures. Patients were randomized to receive intravenous volume supplementation with either (A) sodium chloride 0.9 1 mL/kg/h for at least 12h prior and after the procedure or (B) sodium bicarbonate (166 mEq/L) 3 mL/kg for 1h before and 1 mL/kg/h for 6h after the procedure or (C) sodium bicarbonate (166 mEq/L) 3 mL/kg over 20min before the procedure plus sodium bicarbonate orally (500 mg per 10 kg). The primary endpoint was the change in estimated glomerular filtration rate (eGFR) within 48h after contrast. Secondary endpoints included the development of CIN. The maximum change in eGFR was significantly greater in Group B compared with Group A mean difference -3.9 [95 confidence interval (CI), -6.8 to -1] mL/min/1.73 m2, P = 0.009 and similar between Groups C and B [mean difference 1.3 (95 CI, -1.74.3) mL/min/1.73 m2, P = 0.39]. The incidence of CIN was significantly lower in Group A (1) vs. Group B (9, P = 0.02) and similar between Groups B and C (10, P = 0.9). ConclusionVolume supplementation with 24 h sodium chloride 0.9 is superior to sodium bicarbonate for the prevention of CIN. A short-term regimen with sodium bicarbonate is non-inferior to a 7 h regimen.

KW - Contrast-induced nephropathy

KW - Prevention

KW - Sodium bicarbonate

KW - Sodium chloride

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