• Critical care medicine · Apr 2017

    Sodium Bicarbonate Versus Sodium Chloride for Preventing Contrast-Associated Acute Kidney Injury in Critically Ill Patients: A Randomized Controlled Trial.

    • Xavier Valette, Isabelle Desmeulles, Benoit Savary, Romain Masson, Amélie Seguin, Bertrand Sauneuf, Jennifer Brunet, Pierre Verrier, Véronique Pottier, Marie Orabona, Désiré Samba, Gérald Viquesnel, Mathilde Lermuzeaux, Pascal Hazera, Jean-Jacques Dutheil, Jean-Luc Hanouz, and Jean-Jacques Parienti.
    • 1Department of Medical Intensive Care, CHU de Caen, Caen, France.2Department of Anesthesiology and Surgical Intensive Care, CHU de Caen, Caen, France.3Department of Intensive Care, Centre Hospitalier General Mémorial France Etats-Unis, Saint Lô, France.4Department of Biostatistics and Clinical Research, CHU de Caen, Caen, France.5Université de Caen Normandie, Caen, France.
    • Crit. Care Med. 2017 Apr 1; 45 (4): 637-644.

    ObjectivesTo test whether hydration with bicarbonate rather than isotonic sodium chloride reduces the risk of contrast-associated acute kidney injury in critically ill patients.DesignProspective, double-blind, multicenter, randomized controlled study.SettingThree French ICUs.PatientsCritically ill patients with stable renal function (n = 307) who received intravascular contrast media.InterventionsHydration with 0.9% sodium chloride or 1.4% sodium bicarbonate administered with the same infusion protocol: 3 mL/kg during 1 hour before and 1 mL/kg/hr during 6 hours after contrast medium exposure.Measurements And Main ResultsThe primary endpoint was the development of contrast-associated acute kidney injury, as defined by the Acute Kidney Injury Network criteria, 72 hours after contrast exposure. Patients randomized to the bicarbonate group (n = 151) showed a higher urinary pH at the end of the infusion than patients randomized to the saline group (n = 156) (6.7 ± 2.1 vs 6.2 ± 1.8, respectively; p < 0.0001). The frequency of contrast-associated acute kidney injury was similar in both groups: 52 patients (33.3%) in the saline group and 53 patients (35.1%) in the bicarbonate group (absolute risk difference, -1.8%; 95% CI [-12.3% to 8.9%]; p = 0.81). The need for renal replacement therapy (five [3.2%] and six [3.9%] patients; p = 0.77), ICU length of stay (24.7 ± 22.9 and 23 ± 23.8 d; p = 0.52), and mortality (25 [16.0%] and 24 [15.9%] patients; p > 0.99) were also similar between the saline and bicarbonate groups, respectively.ConclusionsExcept for urinary pH, none of the outcomes differed between the two groups. Among ICU patients with stable renal function, the benefit of using sodium bicarbonate rather than isotonic sodium chloride for preventing contrast-associated acute kidney injury is marginal, if any.

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