Coronary artery diseaseA New Protocol Using Sodium Bicarbonate for the Prevention of Contrast-Induced Nephropathy in Patients Undergoing Coronary Angiography
Section snippets
Methods
We prospectively enrolled patients undergoing coronary angiography or intervention at 2 Japanese hospitals from November 2004 through May 2007. Indications for coronary angiography or intervention for each patient were left to the discretion of each clinical cardiologist. All patients were ≥20 years old and had an estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m2. Exclusion criteria included serum creatinine levels >4 mg/dl, changes in serum creatinine levels of ≥0.5 mg/dl during
Results
In total 158 patients were randomized to receive sodium bicarbonate plus sodium chloride (n = 79) or sodium chloride (n = 79), with 155 patients completing the study. Of the 158 patients, 3 did not complete the study. Two patients in the chloride group had no follow-up laboratory test results. In the bicarbonate group, 1 patient had to interrupt the infusion of sodium bicarbonate because of angialgia.
Clinical characteristics of the 155 patients who completed the study are listed in Table 1.
Discussion
The major finding of this study is that treatment of patients with sodium bicarbonate plus sodium chloride before and after coronary angiography decreased the incidence of CIN compared to use of sodium chloride alone. In addition, eGFR was improved not only in the short term but also for the long term in patients treated with sodium bicarbonate plus sodium chloride.
The mechanism by which CIN occurs is not well understood. The 2 major theories are renal vasoconstriction and direct renal tubular
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2014, Australian Critical CareCitation Excerpt :Limited studies have reported improvements in using it over sodium chloride48 while other studies found no improvement.49,50 In contrast, a few studies suggested the use of both sodium chloride and sodium bicarbonate together, for they were found to produce significantly better results in decreasing the event of CIN in patients undergoing coronary angiography.51 Still other studies found significant decrease in the incidence of CIN when sodium bicarbonate and NAC were used together as compared to CIN and hydration alone.52
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