No Difference Found In Effects On Kidneys Of Contrast Agents In Coronary Angiography Patients

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Main Category: Urology / Nephrology
Also Included In: Cardiovascular / Cardiology
Article Date: 03 Sep 2008 - 0:00 PDT

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According to an article published in the September issue of JAMA, there is little difference in improvement of outcomes between two types of hydration techniques - sodium bicarbonate and sodium chloride - during coronary angiography for patients with kidney disease. Researchers found that use of sodium bicarbonate did not reduce the risk of developing serious kidney problems related to contrast agents compared to use of sodium chloride.

It is well known that exposure to iodine (a contrast agent) during angiography is associated with nephropathy - a disorder involving the kidneys or kidney function. Nephropathy that is induced by a contrast medium commonly causes kidney failure, which leads to extended hospitalization, increased health care costs, and substantial illness and death. In low-risk populations, contrast-induced nephropathy occurs in about 2% of patients, but in high-risk populations, the complication occurs in about 50% of patients. In animal models and one randomized clinical trial, researchers have suggested that hydration with sodium bicarbonate may be an effective means of preventing contrast-induced nephropathy.

To compare the effects of sodium bicarbonate and sodium chloride on preventing contrast medium-induced nephropathy, research Somjot S. Brar, M.D. (Columbia University Medical Center, New York) and colleagues conducted a randomized, controlled trial. They selected a sample of 353 patients (age 71 on average) who were undergoing coronary angiography and had moderate to severe kidney disease. Randomization placed 178 patients into a group that received sodium chloride and 175 patients in a group that received sodium bicarbonate. The sodium-based compounds were administered before, during and after coronary angiography. Forty-five percent of participants had diabetes mellitus.

Contrast-induced nephropathy was measured by estimated glomerular filtration rate (GFR) - the rate at which the kidney filters fluids), and the researchers found that it occurred in 13.9% of patients (45 of 323). The rate of nephropathy for the group receiving sodium chloride hydration was 14.6% compared to a rate of 13.3% in the sodium bicarbonate group. In addition, rates of death, dialysis, heart attack, and cerebrovascular events at 30 days or 30 days to 6 months were not significantly different between the sodium bicarbonate and the sodium chloride patients.

Brar and colleagues conclude: "The results of this study do not suggest that hydration with sodium bicarbonate is superior to hydration with sodium chloride in patients with moderate to severe chronic kidney disease who are undergoing coronary angiography. The overall incidence of contrast-induced nephropathy among patients was 13.9 percent and did not differ by treatment assignment. The frequency of clinical adverse events did not significantly differ between groups. Any true difference between the hydration strategies is likely to be small and not clinically significant."

Sodium Bicarbonate vs Sodium Chloride for the Prevention of Contrast Medium-Induced Nephropathy in Patients Undergoing Coronary Angiography: A Randomized Trial
Somjot S. Brar; Albert Yuh-Jer Shen; Michael B. Jorgensen; Adam Kotlewski; Vicken J. Aharonian; Natasha Desai; Michael Ree; Ahmed Ijaz Shah; Raoul J. Burchette
JAMA (2008). 300[9]:1038-1046.
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Written by: Peter M Crosta
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