All patients had baseline creatinine greater than 1.2. Two hundred and sixty-four patients were randomized to receive, for six hours before and six hours after angioplasty, either:

• One hundred cc/hour of saline,
• 154 mL of 1000-mEq/L sodium bicarbonate added to 846 mL of 5% dextrose in water, or
• Saline plus Mucormist 600 mg twice daily

The findings:

When we head-to-head compared each treatment group, the incidence of contrast induced nephropathy was significantly lower in the sodium bicarbonate group (4.5%) compared with the sodium chloride group (13.6%, P = .036) and tended to be lower than in the NAC group (12.5%, P = .059)

This is a common and difficult situation – a patient with renal insufficiency who needs cardiac catheterization. You try to avoid doing the cath, because you don’t want to land the patient on dialysis by damaging the kidnies further with a big dose of contrast dye. When you have no choice (working kidnies won’t help the patient much if she dies of a massive heart attack), you would at least like a regimen to minimize the renal damage.

The convention at our hospital has been saline and Mucomist. Perhaps we should consider sodium bicarbonate instead.

Comparison of three regimens to prevent contrast-induced nephropathy