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 F., Ozdemir K., Altunkas F., Celik A., DOĞDU O. , Karayakali M., ...Daha Fazla

JOURNAL OF INVESTIGATIVE MEDICINE, cilt.61, ss.872-877, 2013 (SCI İndekslerine Giren Dergi) identifier identifier identifier

  • Cilt numarası: 61 Konu: 5
  • Basım Tarihi: 2013
  • Dergi Adı: JOURNAL OF INVESTIGATIVE MEDICINE
  • Sayfa Sayıları: ss.872-877

Özet

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).

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: j0.03 mg/dL (IQR,

j0.09 to 0.10 mg/dL) versus 0.02 mg/dL (IQR, j0.09 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,

j0.08 mg/dL (IQR, j0.13 to j0.04 mg/dL), in the saline group than

in the bicarbonate group, 0.03 mg/dL (IQR, j0.13 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.