Sodium bicarbonate, sodium chloride comparable in preventing ...

Tag : sodium

In a study of kidney disease patients undergoing coronaryangiography, sodium bicarbonate (NaHCO3) was no better than sodiumchloride (NaCl) in preventing contrast-induced nephropathy.
Findings from animal studies and from one clinical trial hadsuggested that sodium bicarbonate might be effective in preventingthis complication, which is associated with considerable morbidityand mortality. Proponents believed that by alkalinizing the urine,sodium bicarbonate could reduce free radical formation, which inturn, would prevent injury and nephropathy.
Dr. Somjot S. Brar, from Columbia University Medical Center in NewYork, and colleagues addressed this topic by assessing theglomerular filtration rate (GFR) in 353 patients with moderate tosevere chronic kidney disease who were randomized to receive sodiumbicarbonate or sodium chloride around the time of coronaryangiography.
The median patient age was 71 years and 45 per cent of subjects haddiabetes. To be eligible for the study, patients were required tohave an estimated GFR of 60 mL/min per 1.73 meters-squared or less,and have diabetes, history of heart failure, hypertension, or ageolder than 75 years.
Both electrolyte solutions were started at 3 mL/kg for one hourbefore angiography and then reduced to 1.5 mL/kg during theprocedure and for four hours afterward, according to the report inthe Journal of the American Medical Association for September 3rd.
A comparable proportion of patients in each group - roughly 14 percent - achieved the primary endpoint, a drop in the estimated GFRof 25 per cent or greater on days one through four postprocedure.
Moreover, there were also no significant differences between thegroups in rates of death, dialysis, MI, and stroke at 30 days or upto six months, the report indicates.
The results suggest that sodium bicarbonate offers no advantageover sodium chloride in staving off contrast-induced nephropathy inthe current patient population, the investigators conclude. "Anytrue difference between the hydration strategies," they add, "islikely to be small and not clinically significant."
JAMA 2008;300:1038-1046