Korean J Med.  2011 May;80(5):537-545.

Intravenous Sodium Bicarbonate and Oral N-acetylcysteine for the Prevention of Contrast-Induced Nephropathy

• Koo TY
• Kim JH
• Lee J
• Shin JH
• Kim KS
• Choi BY
• Park JS
• Lee CH
• Kang CM
• Kim GH

Abstract

BACKGROUND/AIMS
The value of hydration with sodium bicarbonate and N-acetylcysteine (NAC) in the prevention of radiocontrast-induced nephropathy is questionable. This study investigated whether sodium bicarbonate hydration with or without NAC has a more protective role in the prevention of radiocontrast-induced nephropathy than saline hydration with or without NAC.
METHODS
We prospectively studied 100 patients with significant proteinuria (> or = 500 mg/d), azotemia (serum creatinine > or = 1.5 mg/dL), or diabetes mellitus who were undergoing coronary angiography using iodixanol, a nonionic iso-osmolar contrast agent. Patients were assigned randomly to receive saline infusion (S, n = 24), saline infusion plus NAC (S + NAC, n = 20), sodium bicarbonate infusion (B, n = 25), and sodium bicarbonate plus NAC (B + NAC, n = 31). Contrast-induced nephropathy was defined as an increase of 25% or more in the serum creatinine within 48 hours of contrast exposure.
RESULTS
There were no significant group differences in age, sex, and basal serum creatinine. Contrast-induced nephropathy occurred in 20 patients (20%) and its incidence was not significantly different among the groups; four from group S, five from group S + NAC, five from group B, and six from group B + NAC. The incidences were not significantly different when compared between S and B, irrespective of the use of NAC (21 vs. 20%), and when compared according to the presence of pre-existing azotemia (19 vs. 20%).
CONCLUSIONS
The efficacy of sodium bicarbonate hydration in the prevention of contrast-induced nephropathy seems comparable to that of saline hydration, and it was not improved by the addition of NAC.

Keyword

Contrast media; Acute kidney failure; Sodium chloride; Sodium bicarbonate; Acetylcysteine

MeSH Terms

Acetylcysteine
Acute Kidney Injury
Azotemia
Contrast Media
Coronary Angiography
Creatinine
Diabetes Mellitus
Humans
Incidence
Prospective Studies
Proteinuria
Sodium
Sodium Bicarbonate
Sodium Chloride
Triiodobenzoic Acids
Acetylcysteine
Contrast Media
Creatinine
Sodium
Sodium Bicarbonate
Sodium Chloride
Triiodobenzoic Acids