PLoS ONE (Jan 2018)

Randomized trial of one-hour sodium bicarbonate vs standard periprocedural saline hydration in chronic kidney disease patients undergoing cardiovascular contrast procedures.

  • Judith Kooiman,
  • Jean-Paul P M de Vries,
  • Jan Van der Heyden,
  • Yvo W J Sijpkens,
  • Paul R M van Dijkman,
  • Jan J Wever,
  • Hans van Overhagen,
  • Antonie C Vahl,
  • Nico Aarts,
  • Iris J A M Verberk-Jonkers,
  • Harald F H Brulez,
  • Jaap F Hamming,
  • Aart J van der Molen,
  • Suzanne C Cannegieter,
  • Hein Putter,
  • Wilbert B van den Hout,
  • Inci Kilicsoy,
  • Ton J Rabelink,
  • Menno V Huisman

DOI
https://doi.org/10.1371/journal.pone.0189372
Journal volume & issue
Vol. 13, no. 2
p. e0189372

Abstract

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Guidelines advise periprocedural saline hydration for prevention of contrast induced-acute kidney injury (CI-AKI). We analysed whether 1-hour sodium bicarbonate hydration administered solely prior to intra-arterial contrast exposure is non-inferior to standard periprocedural saline hydration in chronic kidney disease (CKD) patients undergoing elective cardiovascular diagnostic or interventional contrast procedures.We performed an open-label multicentre non-inferiority trial between 2011-2014. Patients were randomized to 1 hour pre-procedure sodium bicarbonate hydration (250 ml 1.4%, N = 168) or 4-12 hours saline hydration (1000 ml 0.9%, N = 165) prior to and following contrast administration (2000 ml of saline total). Primary outcome was the relative serum creatinine increase (%) 48-96 hours post contrast exposure. Secondary outcomes were: incidence of CI-AKI (serum creatinine increase>25% or >44μmol/L), recovery of renal function, the need for dialysis, and hospital costs within two months follow-up.Mean relative creatinine increase was 3.1% (95%CI 0.9 to 5.2%) in the bicarbonate and 1.1% (95%CI -1.2 to 3.5%) in the saline arm, mean difference 1.9% (95%CI -1.2 to 5.1%, p-non-inferiority <0.001). CI-AKI occurred in 11 (6.7%) patients randomized to sodium bicarbonate and 12 (7.5%) to saline (p = 0.79). Renal function did not fully recover in 40.0% and 44.4% of CI-AKI patients, respectively (p = 0.84). No patient required dialysis. Mean costs for preventive hydration and clinical preparation for the contrast procedure were $1158 for sodium bicarbonate vs. $1561 for saline (p < 0.001).Short hydration with sodium bicarbonate prior to elective cardiovascular diagnostic or therapeutic contrast procedures is non-inferior to standard periprocedural saline hydration in CKD patients with respect to renal safety and results in considerable healthcare savings.Netherlands Trial Register (http://www.trialregister.nl/trialreg/index.asp), Nr NTR2699.