HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text (Rapid PDF) All Versions of this Article: CJN.03100707v1 3/1/10    most recent Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by From, A. M. Articles by McDonald, F. S. Search for Related Content PubMed PubMed Citation Articles by From, A. M. Articles by McDonald, F. S.

Received July 29, 2007
Accepted on October 20, 2007

ORIGINAL ARTICLES

Sodium Bicarbonate is Associated with an Increased Incidence of Contrast Nephropathy: A Retrospective Cohort Study of 7977 Patients at Mayo Clinic

Aaron M. From ^*1, Brian J. Bartholmai , Amy W. Williams , Stephen S. Cha , Axel Pflueger , and Furman S. McDonald ^||

*Division of Cardiology, Department of Radiology, Division of Nephrology, Division of Biostatistics, and ||Division of General Internal Medicine, Hospital Internal Medicine, Mayo Clinic, Rochester, Minnesota

¹ To whom correspondence should be addressed. E-mail: from.aaron{at}mayo.edu.

	Abstract

Background and objectives: The role of sodium bicarbonate in preventing contrast nephropathy needs to be evaluated in clinical settings.

Design, setting, participants, & measurements: We performed a retrospective cohort study at Mayo Clinic in Rochester, Minnesota, to assess the risk of contrast nephropathy associated with the use of sodium bicarbonate, N-acetylcysteine, and the combination of sodium bicarbonate with N-acetylcysteine from April 2004 to May 2005. Contrast nephropathy was defined as postexposure creatinine elevation of 25% or >0.5 mg/dl within 7 d of contrast exposure.

Results: A total of 11,516 contrast exposures in 7977 patients had creatinine values available for review before and after contrast exposure. More than 90% of exposures to agents prophylactic for contrast nephropathy were available for analysis. Sodium bicarbonate was used in 268 cases, N-acetylcysteine was used in 616 cases, and both agents were used in combination in 221 cases of contrast exposure. After adjustment for total volume of hydration, medications, age, gender, prior creatinine, contrast iodine load, prior exposure to contrast material, type of imaging study, heart failure, hypertension, renal failure, multiple myeloma, and diabetes mellitus, use of sodium bicarbonate alone was associated with an increased risk of contrast nephropathy compared with no treatment (odds ratio 3.10, 95% confidence interval 2.28 to 4.18; P < 0.001). N-acetylcysteine alone and in combination with sodium bicarbonate was not associated with any significant difference in the incidence of contrast nephropathy.

Conclusions: The use of intravenous sodium bicarbonate was associated with increased incidence of contrast nephropathy. Use of sodium bicarbonate to prevent contrast nephropathy should be evaluated further rather than adopted into clinical practice.

This article has been cited by other articles:

				S. Zoungas, T. Ninomiya, R. Huxley, A. Cass, M. Jardine, M. Gallagher, A. Patel, A. Vasheghani-Farahani, G. Sadigh, and V. Perkovic Systematic Review: Sodium Bicarbonate Treatment Regimens for the Prevention of Contrast-Induced Nephropathy Ann Intern Med, November 3, 2009; 151(9): 631 - 638. [Abstract] [Full Text] [PDF]

				S. S. Brar, S. Hiremath, G. Dangas, R. Mehran, S. K. Brar, and M. B. Leon Sodium Bicarbonate for the Prevention of Contrast Induced-Acute Kidney Injury: A Systematic Review and Meta-analysis Clin. J. Am. Soc. Nephrol., October 1, 2009; 4(10): 1584 - 1592. [Abstract] [Full Text] [PDF]

				E. A. J. Hoste, J. J. De Waele, S. A. Gevaert, S. Uchino, and J. A. Kellum Sodium bicarbonate for prevention of contrast-induced acute kidney injury: a systematic review and meta-analysis Nephrol. Dial. Transplant., August 23, 2009; (2009) gfp389v1. [Abstract] [Full Text] [PDF]

				S. Goldfarb, P. A. McCullough, J. McDermott, and S. B. Gay Contrast-Induced Acute Kidney Injury: Specialty-Specific Protocols for Interventional Radiology, Diagnostic Computed Tomography Radiology, and Interventional Cardiology Mayo Clin. Proc., February 1, 2009; 84(2): 170 - 179. [Abstract] [Full Text] [PDF]

				M. R. Lattanzio and N. P. Kopyt Acute Kidney Injury: New Concepts in Definition, Diagnosis, Pathophysiology, and Treatment J Am Osteopath Assoc, January 1, 2009; 109(1): 13 - 19. [Abstract] [Full Text] [PDF]

				C. A. Herzog Kidney disease in cardiology Nephrol. Dial. Transplant., January 1, 2009; 24(1): 34 - 37. [Full Text] [PDF]

				N. Lameire, W. Van Biesen, E. Hoste, and R. Vanholder The prevention of acute kidney injury: an in-depth narrative review Part 1: volume resuscitation and avoidance of drug- and nephrotoxin-induced AKI NDT Plus, December 1, 2008; 1(6): 392 - 402. [Abstract] [Full Text] [PDF]