Prevention of contrast induced nephropathy with sodium bicarbonate (the PROMEC study)

Jornal Brasileiro de Nefrologia

John Fredy Nieto-ríos¹  Wílmar Arley Maya Salazar¹  Oscar Mauricio Santos Sánchez¹  Janeth Liliana Jaramillo Ortega¹  Jorge Ignacio García Caro¹  Julián Miguel Aristizabal Aristizabal¹  Lina Maria Serna Higuita¹  Álvaro García García¹  Fabián Alberto Jaimes Barragán¹ 

关键词: acute kidney injury;    contrast media;    saline waters;    sodium bicarbonate;    bicarbonato de sódio;    lesão renal aguda;    meios de contraste;    solução salina;   

DOI  :  10.5935/0101-2800.20140051

来源: SciELO

【 摘 要 】

Introduction: Contrast-induced nephropathy is a common complication of radiographic procedures. Different measures have been used to avoid this damage, but the evidence is controversial. New investigations are required to clarify it. We investigated the efficacy and safety of sodium bicarbonate solution compared with sodium chloride solution to prevent contrast induced nephropathy in patients with or at risk of renal dysfunction. Methods: A prospective, single-center, randomized clinical trial conducted from May 1, 2007 to February 8, 2008. Inpatients in a tertiary center, scheduled to undergo a procedure with the nonionic radiographic contrast agent iohexol. There were 220 patients with serum creatinine levels of at least 1.2 mg/dL (106.1 µmol/L) and/or type 2 diabetics, who were randomized to receive an infusion of sodium chloride (n = 113) or sodium bicarbonate (n = 107) before and after contrast dye administration. The intervention were "A" group received 1 ml/kg/hour of normal saline solution, starting 12 hours before and continuing 12 hours after iohexol contrast. "B" group received 3 ml/kg of sodium bicarbonate solution (150 mEq/L) one hour prior to procedure and then drip rate was decreased to 1 ml/kg/hour until 6 hours post procedure. Our main outcome measure was change in serum creatinine. Results: The mean creatinine value after the procedure was 1.26 mg/dL in the saline group and 1.22 mg/dL in the bicarbonate group (mean difference: 0.036; CI 95%: -0.16 to 0.23, p = 0.865). The diagnosis of contrast-induced nephropathy, defined by increase in serum creatinine on 25% or more within 2 days after administration of radiographic contrast, was done in twelve patients (12%) in the bicarbonate group and eighth patients (7.1%) in the saline group (RR: 1.68, CI 95%: 0.72 to 3.94). Conclusion: Our investigation showed that there were no differences between normal saline solution (extended infusion) vs. bicarbonate solution for nephroprotection.

【 授权许可】

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