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Sodium Bicarbonate Versus Sodium Chloride for Preventing Contrast-Associated Acute Kidney Injury in Critically Ill Patients: A Randomized Controlled Trial

Valette, Xavier MD1; Desmeulles, Isabelle MD2; Savary, Benoit MD3; Masson, Romain MD2; Seguin, Amélie MD1; Sauneuf, Bertrand MD1; Brunet, Jennifer MD1; Verrier, Pierre MD2; Pottier, Véronique MD2; Orabona, Marie MD2; Samba, Désiré MD2; Viquesnel, Gérald MD2; Lermuzeaux, Mathilde MD2; Hazera, Pascal MD3; Dutheil, Jean-Jacques4; Hanouz, Jean-Luc MD, PhD2,5; Parienti, Jean-Jacques MD, PhD4; du Cheyron, Damien MD, PhD1,5

doi: 10.1097/CCM.0000000000002267
Clinical Investigations

Objectives: To test whether hydration with bicarbonate rather than isotonic sodium chloride reduces the risk of contrast-associated acute kidney injury in critically ill patients.

Design: Prospective, double-blind, multicenter, randomized controlled study.

Setting: Three French ICUs.

Patients: Critically ill patients with stable renal function (n = 307) who received intravascular contrast media.

Interventions: Hydration with 0.9% sodium chloride or 1.4% sodium bicarbonate administered with the same infusion protocol: 3 mL/kg during 1 hour before and 1 mL/kg/hr during 6 hours after contrast medium exposure.

Measurements and Main Results: The primary endpoint was the development of contrast-associated acute kidney injury, as defined by the Acute Kidney Injury Network criteria, 72 hours after contrast exposure. Patients randomized to the bicarbonate group (n = 151) showed a higher urinary pH at the end of the infusion than patients randomized to the saline group (n = 156) (6.7 ± 2.1 vs 6.2 ± 1.8, respectively; p < 0.0001). The frequency of contrast-associated acute kidney injury was similar in both groups: 52 patients (33.3%) in the saline group and 53 patients (35.1%) in the bicarbonate group (absolute risk difference, –1.8%; 95% CI [–12.3% to 8.9%]; p = 0.81). The need for renal replacement therapy (five [3.2%] and six [3.9%] patients; p = 0.77), ICU length of stay (24.7 ± 22.9 and 23 ± 23.8 d; p = 0.52), and mortality (25 [16.0%] and 24 [15.9%] patients; p > 0.99) were also similar between the saline and bicarbonate groups, respectively.

Conclusions: Except for urinary pH, none of the outcomes differed between the two groups. Among ICU patients with stable renal function, the benefit of using sodium bicarbonate rather than isotonic sodium chloride for preventing contrast-associated acute kidney injury is marginal, if any.

1Department of Medical Intensive Care, CHU de Caen, Caen, France.

2Department of Anesthesiology and Surgical Intensive Care, CHU de Caen, Caen, France.

3Department of Intensive Care, Centre Hospitalier General Mémorial France Etats-Unis, Saint Lô, France.

4Department of Biostatistics and Clinical Research, CHU de Caen, Caen, France.

5Université de Caen Normandie, Caen, France.

Registered at (NCT01636089).

Drs. Parienti and du Cheyron contributed equally.

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Supported, in part, by Caen University Hospital.

Dr. Dutheil received support for article research from CHU CAEN (funding of the hospital). The remaining authors have disclosed that they do not have any potential conflicts of interest.

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