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.