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.