In patients undergoing cardiac catheterization, contrast dye injection can sometimes cause contrast-induced nephropathy (CIN), otherwise known as acute renal failure.
According to a study presented at the American College of Cardiology's Innovation in Intervention: i2Summit, peri-procedural hydration treatment with either sodium bicarbonate or sodium chloride show similar rates of protection against CIN. Innovation in Intervention: i2 Summit is an annual meeting for practicing cardiovascular interventionalists sponsored by the American College of Cardiology in partnership with the Society for Cardiovascular Angiography and Interventions.
Patients undergoing coronary angiography to identify obstructions in the arteries are at risk for CIN, a dye-contrast complication that can lead to extended hospital stays, increased costs, dialysis and in some cases, death. Previous studies have evaluated hydration treatment with both sodium chloride and sodium bicarbonate fluids in animal models. With evidence suggesting sodium bicarbonate may be an effective strategy to improve hydration, researchers designed a human trial to compare the efficacy of sodium chloride versus sodium bicarbonate to prevent CIN in patients undergoing cardiac procedures.
The single-center randomized controlled trial at Kaiser Permanente, Los Angeles Medical Center, evaluated 353 patients with at least moderate renal dysfunction and one or more of the following: age of 75 or older, diabetes mellitus, hypertension or congestive heart failure (CHF). Prior to the cardiac catheterization, patients were randomized to hydration with sodium chloride (n=178) or sodium bicarbonate (n=175). Study participants were given either study fluid at the same rate: 3 mL/kg for one hour before, and 1.5 mL/kg during and for four hours after the cardiac catheterization. Ioxilan, a non-iconic, low osmolar contrast agent was administered during all procedures.