Prevention of Contrast Induced Nephropathy With Sodium Bicarbonate

We will perform a randomized clinical trial following a modification of a previously published protocol (Merten et al.JAMA 2004;291(19):2328-34). Patients will be randomly assigned to one of two groups of treatment. Group A will receive 1 cc/kg/hour of 0.9% saline infusion starting 12 hours before and continuing 12 hours after the procedure. Group B will receive 3 cc/kg of sodium bicarbonate solution for one hour prior to procedure, then drip rate will be decreased to 1 cc/kg/hour until 6 hours post procedure.

Phase 2/3 study Study Type: Interventional Study Design: Prevention, Randomized, Open Label, Active Control, Parallel Assignment, Efficacy Study.

Subjects: Consecutive samples of all inpatients who meet the inclusion criteria

Primary outcomes: Development of contrast induced nephropathy, defined as an increase in serum creatinine of 25% or more within 48 h after administration of contrast.

Secondary outcomes: change in serum bicarbonate; change in serum potassium; change in serum creatinine.

Expected total enrollment: 212

Allocation Assignment: Patients who meet inclusion criteria and agree to participate in the study will be assigned by a random number table to saline or bicarbonate, using closed envelopes and stratifying according to history of diabetes and type of procedure (cardiac catheterism or others).

Condition: Contrast Induced Nephropathy

Intervention: 75 cc of sodium bicarbonate (8.4%) mixed in 425 cc of D5W

Gender: both Age: 18+ years of age Recruitment Status: participants are currently being recruited

Facility location:

Universidad de Antioquia, Internal Medicine Department; Hospital Universitario San Vicente de Paul. Medellin, Colombia.

Inclusion criteria

• 18+ years of age
• Inpatient at Hospital Universitario San Vicente de Paúl scheduled to undergo diagnostic CT scan using contrast or angiography and either

• Serum creatinine 1.2 mg/dl or more, or
• Type 2 Diabetes Mellitus

Exclusion criteria

• Current clinical diagnosis of exacerbated congestive heart failure
• Exposure to contrast 30 days prior to study
• Allergy to contrast dye
• Chronic renal disease with dialysis therapy
• Acute renal failure with dialytic urgency
• Urgency procedure needed
• Systolic blood pressure < 90 or vasopressor support
• No authorization by patient or physician in charge
• Serum potassium < 3 mEq/L
• Ejection fraction < 35% by previous echocardiography
• Acute pulmonary edema in previous 48 hours