Bicarbonaat ter preventie van contrastnefropathie*

Objective

To investigate whether a sodium bicarbonate (NaHCO₃) infusion 1 h prior to CT-scan is non-inferior to the standard peri-procedural saline (NaCl) hydration in preventing contrast nephropathy in patients with chronic kidney disease.

Design

Multicentric open-label randomized study.

Method

Patients were randomized between 1.4% NaHCO₃ 250 ml administered intravenously 1 h prior to CT scan and 0.9% NaCl 1000 ml administered 4-12 h before and after CT scan. The primary outcome measure was the relative serum creatinine increase 48-96 h after CT scan. Secondary outcome measures were the incidence of contrast-induced acute kidney injury (creatinine increase: > 25% or > 44 µmol/l), recovery of renal function, need for dialysis and hospital costs in the 2 months after randomization (Netherlands Trial Register: NTR2149).

Results

From 2010-2012, 570 patients with chronic kidney disease were randomized, of whom 548 were included in the ‘intention to treat’ analysis. The mean relative creatinine increase was 1.2% in the NaHCO₃ arm and 1.5% in the NaCl arm (mean difference: 0.3%; 95% CI: -2.7-2.1; p < 0.001). Twenty-two patients (4.1%) developed contrast-induced acute kidney injury: 8 (3.0%) in the NaHCO₃ arm and 14 (5.1%) in the NaCl arm (p = 0.23). Of patients with contrast-induced acute kidney injury, renal function recovery occurred in75% and 69% of patients, respectively. None of the patients developed an indication for dialysis. Mean hydration costs were € 224 for the NaHCO₃ group and € 683 for the NaCl group.

Conclusion

Brief prehydration with NaHCO₃ was non-inferior to peri-procedural hydration with NaCl for the prevention of contrast-induced acute kidney injury and resulted in significant savings in healthcare costs.

Conflict of interest: none declared. an ICMJE form provided by the author is available online along with the full text of this article.