• Seung-Whan Lee, Won-Jang Kim, Young-Hak Kim, Seong-Wook Park, Duk-Woo Park, Sung-Cheol Yun, Jong-Young Lee, Soo-Jin Kang, Cheol Whan Lee, Jae-Hwan Lee, Si Wan Choi, In-Whan Seong, Jon Suh, Yoon Haeng Cho, Nae-Hee Lee, Sang-Sig Cheong, Sang-Yong Yoo, Bong-Ki Lee, Sang-Gon Lee, Min-Su Hyon, Won-Yong Shin, Se-Whan Lee, Jae-Sik Jang, and Seung-Jung Park.
• Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
• Am. J. Cardiol. 2011 May 15; 107 (10): 1447-52.

AbstractFew studies have compared the ability of sodium bicarbonate plus N-acetylcysteine (NAC) and sodium chloride plus NAC to prevent contrast-induced nephropathy (CIN) in diabetic patients with impaired renal function undergoing coronary or endovascular angiography or intervention. Diabetic patients (n = 382) with renal disease (serum creatinine ≥1.1 mg/dl and estimated glomerular filtration rate <60 ml/min/1.73 m(2)) were randomly assigned to receive prophylactic sodium chloride (saline group, n = 189) or sodium bicarbonate (bicarbonate group, n = 193) before elective coronary or endovascular angiography or intervention. All patients received oral NAC 1,200 mg 2 times/day for 2 days. The primary end point was CIN, defined as an increase in serum creatinine >25% or an absolute increase in serum creatinine ≥0.5 mg/dl within 48 hours after contrast exposure. There were no significant between-group differences in baseline characteristics. The primary end point was met in 10 patients (5.3%) in the saline group and 17 (9.0%) in the bicarbonate group (p = 0.17), with 2 (1.1%) and 4 (2.1%), respectively, requiring hemodialysis (p = 0.69). Rates of death, myocardial infarction, and stroke did not differ significantly at 1 month and 6 months after contrast exposure. In conclusion, hydration with sodium bicarbonate is not superior to hydration with sodium chloride in preventing CIN in patients with diabetic nephropathy undergoing coronary or endovascular angiography or intervention.Copyright © 2011 Elsevier Inc. All rights reserved.

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