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Journal of Investigative Medicine:
doi: 10.231/JIM.0b013e31828e9cab
Original Articles

Sodium Bicarbonate Versus Isotonic Saline for the Prevention of Contrast-Induced Nephropathy in Patients With Diabetes Mellitus Undergoing Coronary Angiography and/or Intervention: A Multicenter Prospective Randomized Study

Koc, Fatih MD*; Ozdemir, Kurtulus MD; Altunkas, Fatih MD*; Celik, Atac MD*; Dogdu, Orhan MD; Karayakali, Metin MD*; Gul, Enes Elvin MD; Erkorkmaz, Unal PhD§; Kadi, Hasan MD*; Akpek, Mahmut MD; Kaya, Mehmet Gungor MD

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Abstract

Introduction

Contrast-induced nephropathy (CIN) is a leading cause of acute renal failure and affects mortality and morbidity. Although the incidence of CIN is quite low in the general population, CIN incidence is significantly increased in patients with diabetes mellitus (DM).

Objectives

We compared the efficacy of prophylactic use consisting of a saline infusion or a sodium bicarbonate infusion for the prevention of CIN in patients with DM.

Materials and Methods

A total of 195 DM patients who had unselected renal function were randomized into 2 groups: 101 patients were assigned to saline infusion, and 94 patients were assigned to bicarbonate infusion. The primary end point was the maximum increase in the serum creatinine (SCr) level, whereas the secondary end point was the development of CIN after the procedure.

Results

The maximum increase in SCr levels was significantly lower in the saline group than in the bicarbonate group: −0.03 mg/dL (IQR, −0.09 to 0.10 mg/dL) versus 0.02 mg/dL (IQR, −0.09 to 0.13 mg/dL) (P = 0.014). The rate of CIN was significantly lower in the saline group than in the bicarbonate group (5.9% vs 16%, P = 0.024). In the subset of study participants with a baseline creatinine clearance of less than 60 mL/min, the maximum increase in SCr levels was significantly lower, −0.08 mg/dL (IQR, −0.13 to −0.04 mg/dL), in the saline group than in the bicarbonate group, 0.03 mg/dL (IQR, −0.13 to 0.12 mg/dL) (P = 0.004).

Conclusions

The use of prophylactic hydration with isotonic saline before coronary procedures may decrease SCr levels and reduce the incidence of CIN in patients with DM with unselected renal functions to a greater extent than sodium bicarbonate can.

Copyright © 2013 by The American Federation for Medical Research

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