Effect of Sodium Bicarbonate Solution in Decreasing the Incidence of Contrast Induced Nephropathy (CIN)
Effect of Sodium Bicarbonate Solution in Decreasing the Incidence of Contrast Induced Nephropathy (CIN)
Radio Contrast Induced Nephropathy (RCIN) remains a well recognized complication in patients
 undergoing diagnostic or interventional procedures requiring radiographic contrast agents.
 Recent studies have shown benefit in administering Sodium Bicarbonate over normal saline( the
 uniformly accepted prophylaxy) in preventing RCIN.Therefore the aim of the study is to
 evaluate the efficacy of sodium bicarbonate solved in normal saline compared with infusion of
 normal saline in prevention of RCIN.
Radio Contrast Induced Nephropathy (RCIN) remains a well recognized complication in patients
 undergoing diagnostic or interventional procedures requiring radiographic contrast agents and
 is the third leading cause of acquired acute renal failure in hospitalized patients.
 Strategies for the prevention of radiocontrast nephropathy have focused on countering
 vasoconstriction (pre-hydration, fenoldopam, and theophylline), enhancing flow through the
 nephron (diuretics), or protection against oxygen-free-radical injury (urinary alkalinization
 and N-acetylcysteine).

 Among all prophylactic measures that have been proposed, adequate preprocedural and
 postprocedural hydration has demonstrated effectiveness in the prevention of radiocontrast
 nephropathy. Thus, it remains the most frequently applied measure in clinical practice.

 A Recent study in May 2004 have shown benefit in administering Sodium Bicarbonate over normal
 saline as a prophylaxy.Since alkalizing renal tubular fluid with bicarbonate may reduce
 injury.

 Comparisons: IV 154 mEq/L solution of NaCl 0.9% OR IV 154 mEq/ L sodium bicarbonate solved in
 154 mEq/ L NaCl 0.9%. Each fluid is infused at the rate of 3 ml/kg/ hour one hour before the
 angiographic procedure, continuing at the rate of 1 ml/kg/ hour for 6 hours after the
 procedure. Maximum rate of fluid permitted is that for a body weight of 110 Kg.
Inclusion Criteria:

 -  individuals aged 18 years or older with stable serum creatinine levels of at least 1.5
 mg/dl , who were scheduled to undergo diagnostic or therapeutic coronary artery
 angiography during the next 24 hours of hospitalization and were available until 5
 days after the procedure for serum creatinine measurements.

 Exclusion Criteria:

 -  serum creatinine levels of more than 8 mg/dl

 -  previous history of dialysis

 -  eGFR < 20

 -  emergency catheterization

 -  recent exposure to radiographic contrast agents (within previous two days of the
 study)

 -  radiocontrast agent dosage needed more than 300 cc during the procedure

 -  allergy to radiocontrast agent

 -  pregnancy

 -  administration of dopamine, mannitol , fenoldopam or N-Acetyl Cystein during the
 intended time of study

 -  need for continuous hydration therapy (e.g. sepsis )

 -  history of Multiple myeloma , Pulmonary edema , Uncontrolled hypertension (treated
 systolic blood pressure more than 160 mmHg, or diastolic blood pressure more than
 100mmHg.) ,Severe heart failure (EF < 30% or NYHA 3-4).