NEW YORK (Reuters Health) – In patients with mild renal insufficiency, a single IV bolus of sodium bicarbonate can help prevent contrast-induced nephropathy (CIN) during percutaneous coronary intervention (PCI) or coronary arteriography, Japanese researchers report.

“Five randomized studies have demonstrated that hydration with sodium bicarbonate is useful to prevent CIN in patients undergoing a coronary or peripheral procedure, whereas two randomized studies have reported conflicting results,” Dr. Akira Tamura, from Oita University, Yufu, and co-researchers note.

Moreover, the authors point out, “No information is so far available on the efficacy of single-bolus IV administration of sodium bicarbonate immediately before contrast exposure for prevention of CIN.”

In the current study, reported in the American Journal of Cardiology for October 1, 144 patients who were undergoing an elective coronary procedure were randomized to receive standard sodium chloride hydration with or without a bolus of sodium bicarbonate (20 mEq) immediately before contrast exposure. All subjects had serum creatinine levels of >1.1 to <2.0 mg/dL. The bicarbonate group was less likely than the control group to develop CIN (1.4% vs. 12.5%, p = 0.017), defined as an increase in serum creatinine of more than 25% or more than 0.5 mg/dL within 3 days of the procedure. No significant difference in adverse events, including acute renal failure requiring dialysis, acute pulmonary edema, and death within 7 days of the procedure, were noted between the bicarbonate and control groups (0% vs. 1.4%). Further research, the authors note, is needed to determine if the bicarbonate intervention actually improves clinical outcomes in this patient population. Reference:
Am J Cardiol 2009;104:921-925.