Contrast-Induced Acute Kidney Injury: Sodium Bicarbonate vs Sodium Chloride

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It is likely that the current interventions used to prevent acute kidney injury in angiography are effective.
It is likely that the current interventions used to prevent acute kidney injury in angiography are effective.

Intravenous sodium bicarbonate is not superior to intravenous sodium chloride for reducing the risk for death or contrast-induced acute kidney injury (AKI) in patients who are at risk for renal complications and are undergoing angiography, according to a randomized trial published in the New England Journal of Medicine.1

Results were simultaneously presented at the 2017 American Heart Association Scientific Sessions held November 11-15 in Anaheim, California.

Investigators randomly assigned 4993 patients to receive intravenous 0.9% sodium chloride (n=2482) or intravenous 1.26% sodium bicarbonate (n=2511) followed by oral acetylcysteine (n=2495) or placebo (n=2498). All patients were at risk for renal complications and were scheduled for angiography.

At 90 days, the investigators observed no difference between the sodium chloride and sodium bicarbonate groups in regard to the achievement of the primary end point of death, need for dialysis, or at least a 50% increase in serum creatinine (4.7% vs 4.4%, respectively; odds ratio [OR], 0.93; 95% CI, 0.72-1.22; P =.62). In addition, there were no significant differences between the acetylcysteine and placebo groups for achievement of the primary end point (4.6% vs 4.5%, respectively; OR, 1.02; 95% CI, 0.78-1.33; P =.88).

In addition, patients receiving intravenous sodium bicarbonate did not experience significantly higher rates of contrast-induced AKI than those receiving intravenous sodium chloride (9.5% vs 8.3%, respectively; OR, 1.16; 95% CI, 0.96-1.41; P =.13), nor were there any significant differences between acetylcysteine or placebo with regard to AKI incidence (9.1% vs 8.7%, respectively; OR, 1.06; 95% CI, 0.87-1.28; P =.58).

Because the trial investigators enrolled mostly male participants from Veterans Affairs hospitals, it is uncertain whether the findings are applicable to all patients at risk for renal complications.

The similar effects associated with the therapies observed in these patients suggest "the strong likelihood that these interventions are not clinically effective in preventing [AKI] or longer-term adverse outcomes after angiography," the authors wrote.

Reference

Weisbord SD, Gallagher M, Jneid H, et al. Outcomes after angiography with sodium bicarbonate and acetylcysteine [published online November 12, 2017]. N Engl J Med. doi:10.1056/NEJMoa1710933

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