Preventing radiocontrast-induced nephropathy in chronic kidney disease patients undergoing coronary angiography

Table 6 Clinical trials showing benefit of IV bicarbonate over saline to prevent radiocontrast-induced nephropathy after angiography

Ref.	Inclusion criteria	No. of patients	Hydration protocol	Contrast media type	Results: RCIN in bicarbonate group vs saline group	Dialysis and death rate
Merten et al[149] (2004) CT/coronary angiography	SCr ≥ 1.1 mg/dL	119	0.9% NaCl 1 mL/kg per hour for 12 h pre- and post-procedure	Iopamidol	1.7% vs 13.6% (P = 0.02)	Dialysis rate 0%
Ozcan et al[152] (2007) coronary angiography/PCI	SCr > 1.2 mg/dL	264	0.9% NaCl 200 mL 12 h pre- and D5W 20 mL/h for 12 h pre and post-procedure	Ioxaglate	4.5% vs 13.6% (P = 0.036)	Dialysis rate 1%
Briguori et al[150] (2007) coronary/peripheral angiography	SCr ≥ 2.0 mg/dL or eGFR < 40 mL/min per 1.73 m2	326	0.9% NaCl 500 mL over 4-6 h at 6-12 h before and after the procedure	Iodixanol	1.9% vs 9.9% (P = 0.019)	Dialysis rate 1%
Masuda et al[151] (2007) emergency coronary angiography/PCI	SCr ≥ 1.1 mg/dL or eGFR < 60 mL/min	59	D5W/0.9% NaCl 50 mL as a bolus within 1 h before the procedure and 200 mL 0.9% NaCl	Iopamidol	6.7% vs 34.5% (P = 0.01)	Dialysis rate 7%; death rate 3%
Recio-Mayoral et al[108] (2007) emergency PCI	None	111	Sodium bicarbonate 5 mL/kg per hour 1 h before the procedure and 1.5 mL/kg per hour for 12 h after the procedure	Iomeprol	1.8% vs 21.8% (P < 0.001)	Dialysis rate 4%; death rate 4.5%
Pakfetrat et al[153] (2009) coronary angiography/PCI	SCr > 1.2 mg/dL	192	Bicarbonate in dextrose infusion, normal saline infusion alone or combined with oral acetazolamide before procedure	Iodixanol	4.2% vs 12.5% (P < 0.001)	NA
Tamura et al[154] (2009) elective coronary angiography	SCr > 1.1 to < 2.0 mg/dL) undergoing an elective coronary	144	Single-bolus intravenous administration of sodium bicarbonate (20 mEq) immediately before contrast exposure	Iopamidol	10.3% vs 10.1% (P = 0.5)	NA
Ueda et al[155] (2011) emergent coronary procedures	SCr > 1.2 mg/dL	59	A bolus intravenous injection of 154 mEq/L of sodium bicarbonate or saline at the dose of 0.5 mL/kg, before CM, followed by infusion of 154 mEq/L sodium bicarbonate at 1 mL/kg per hour for 6 h in both groups	Iopamidol	3.3% vs 27.6% (P = 0.01)	NA

RCIN: Radiocontrast induced nephropathy; NaCl: Sodium chloride; D5W: 5% dextrose; PCI: Percutaneous coronary intervention; NA: Not assessed.