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A comparison of sodium bicarbonate infusion versus normal saline infusion and its combination with oral acetazolamide for prevention of contrast-induced nephropathy: a randomized, double-blind trial

  • Nephrology - Original Paper
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Abstract

Background

Contrast-induced nephropathy (CIN) is commonly encountered. Because the therapy of choice for prevention of CIN is controversial, in this study we compared the preventive efficacy of bicarbonate (Bi) infusion in dextrose water versus normal saline (NLS) infusion alone or in combination with oral acetazolamide (AZ).

Methods

In a double-blind and randomized clinical trial, all patients undergoing coronary angiography or percutaneous coronary intervention received NLS (NLS group), its combination with AZ (AZ group) or infusion of Bi (Bi group) before the procedures. RIFLE (risk of renal failure, injury to the kidney, failure of kidney function, loss of kidney function, and end-stage renal disease) criteria were used to define CIN-associated acute kidney injury (AKI).

Results

The risk of AKI in CIN was significantly lower in the Bi and AZ groups than in the NLS group (P ≤ 0.04). Comparing pre-treatment and post-treatment values in each group the following results were obtained: serum creatinine (Scr) increased and eGFR decreased significantly in the NLS group (P = 0.04) and in all patients (P = 0.001, P = 0.02, respectively). In addition, serum potassium decreased significantly in the Bi and NLS groups (P ≤ 0.02). Also, serum Bi increased significantly in the Bi group (P = 0.001) whereas it decreased significantly in the AZ group (P = 0.001). Urinary pH also increased in all groups (P ≤ 0.04) except the NLS group (P > 0.05).

Conclusions

It seems that both Bi and AZ reduce the risk of CIN-related AKI, and close monitoring of serum potassium is needed during bicarbonate infusion.

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Acknowledgments

This study was funded by: The Shiraz Nephro-Urology Research Center of Shiraz University of Medical Sciences, and The Fars Heart Foundation (Kowsar Hospital).

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Authors and Affiliations

  1. Shiraz Nephro-Urology Research Center, Shiraz University of Medical Sciences, P.O. Box 71348, Shiraz, 14336, Iran

    Maryam Pakfetrat, Leila Malekmakan, Jamshid Roozbeh, Mahshid Hashemi Nasab, Najmeh Moin Vaziri & Parviz Khajehdehi

  2. Fars Heart Foundation, Kowsar Hospital, Shiraz University of Medical Sciences, Shiraz, Iran

    Mohammad Hossein Nikoo, Mahmood Tabandeh, Soheila Salari, Mohammad Kafi, Farzad Adl & Mehdi Hosseini

  3. Cardiac Department, Shiraz University of Medical Sciences, Shiraz, Iran

    Mohammad Ali Ostovan

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  1. Maryam Pakfetrat
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  2. Mohammad Hossein Nikoo
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Correspondence to Parviz Khajehdehi.

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Pakfetrat, M., Nikoo, M.H., Malekmakan, L. et al. A comparison of sodium bicarbonate infusion versus normal saline infusion and its combination with oral acetazolamide for prevention of contrast-induced nephropathy: a randomized, double-blind trial. Int Urol Nephrol 41, 629–634 (2009). https://doi.org/10.1007/s11255-008-9520-y

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  • DOI: https://doi.org/10.1007/s11255-008-9520-y

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