Hidratação com bicarbonato de sódio não previne a nefropatia de contraste: ensaio clínico multicêntrico

• Main Author: Gomes, Vitor O.
• Publication Date: 2012
• Other Authors: Lasevitch, Ricardo, Lima, Valter C. [UNIFESP], Brito Jr., Fábio S., Perez-alva, Juan Carlos, Moulin, Bruno, Arruda, Airton, Oliveira, Denise, Caramori, Paulo
• Format: Article
• Language: por
• Source: Repositório Institucional da UNIFESP
• Download full: http://dx.doi.org/10.1590/S0066-782X2012005000108; http://repositorio.unifesp.br/handle/11600/7434
• topic: Kidney diseases; fluid therapy; sodium bicarbonate; coronary angiography; clinical trial; Nefropatias; hidratação; bicarbonato de sódio; angiografia coronária; ensaio clínico

BACKGROUND: Radiographic contrast media exposition can cause acute renal function impairment. There is limited and conflicting evidence that hydration with sodium bicarbonate prevents contrast-induced nephropathy (CIN) in patients undergoing cardiac catheterization. OBJECTIVE: The present study was aimed at determining whether sodium bicarbonate is superior to hydration with saline to prevent nephropathy in patients at risk undergoing cardiac catheterization. METHODS: Three hundred and one patients undergoing coronary angiography or percutaneous coronary intervention with serum creatinine > 1.2mg/dL or glomerular filtration rate (GFR) < 50ml/min were randomized to receive hydration with sodium bicarbonate starting 1 hour before the procedure and 6 hours after the procedure, or hydration with 0.9% saline. CIN was defined as an increase of 0.5mg/dL in creatinine in 48h RESULTS: Eighteen patients (5.9%) developed contrast induced nephropathy: 9 patients in the bicarbonate group (6.1%) and 9 patients in the saline group (6.0%), p = 0.97. The change in serum creatinine was similar in both groups, 0.01 ± 0.26 mg/dL in the bicarbonate group and 0.01 ± 0.35 mg/dL in the saline group, p = 0.9. No statistical difference was observed between the change in glomerular filtration rate (0.89 ± 9 ml/min vs. 2.29 ± 10 ml/min, p = 0.2 bicarbonate group and saline group, respectively). CONCLUSION: Hydration with sodium bicarbonate was not superior to saline to prevent contrast media induced nephropathy in patients at risk undergoing cardiac catheterization.