Sodium bicarbonate is associated with an increased incidence of contrast nephropathy: A retrospective cohort study of 7977 patients at Mayo Clinic

Aaron M. From, Brian Jack Bartholmai, Amy W. Williams, Stephen S. Cha, Axel Pflueger, Furman S. McDonald

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Abstract

Background and objectives: The role of sodium bicarbonate in preventing contrast nephropathy needs to be evaluated in clinical settings. Design, setting, participants, & measurements: We performed a retrospective cohort study at Mayo Clinic in Rochester, Minnesota, to assess the risk of contrast nephropathy associated with the use of sodium bicarbonate, N-acetylcysteine, and the combination of sodium bicarbonate with N-acetylcysteine from April 2004 to May 2005. Contrast nephropathy was defined as postexposure creatinine elevation of ≥25% or >0.5 mg/dl within 7 d of contrast exposure. Results: A total of 11,516 contrast exposures in 7977 patients had creatinine values available for review before and after contrast exposure. More than 90% of exposures to agents prophylactic for contrast nephropathy were available for analysis. Sodium bicarbonate was used in 268 cases, N-acetylcysteine was used in 616 cases, and both agents were used in combination in 221 cases of contrast exposure. After adjustment for total volume of hydration, medications, age, gender, prior creatinine, contrast iodine load, prior exposure to contrast material, type of imaging study, heart failure, hypertension, renal failure, multiple myeloma, and diabetes mellitus, use of sodium bicarbonate alone was associated with an increased risk of contrast nephropathy compared with no treatment (odds ratio 3.10, 95% confidence interval 2.28 to 4.18; P < 0.001). N-acetylcysteine alone and in combination with sodium bicarbonate was not associated with any significant difference in the incidence of contrast nephropathy. Conclusions: The use of intravenous sodium bicarbonate was associated with increased incidence of contrast nephropathy. Use of sodium bicarbonate to prevent contrast nephropathy should be evaluated further rather than adopted into clinical practice.

Original languageEnglish (US)
Pages (from-to)10-18
Number of pages9
JournalClinical Journal of the American Society of Nephrology
Volume3
Issue number1
DOIs
StatePublished - Jan 2008

Fingerprint

Sodium Bicarbonate
Cohort Studies
Retrospective Studies
Acetylcysteine
Incidence
Creatinine
Contrast Media
Multiple Myeloma
Iodine
Renal Insufficiency
Diabetes Mellitus
Heart Failure
Odds Ratio
Confidence Intervals
Hypertension

ASJC Scopus subject areas

  • Medicine(all)
  • Critical Care and Intensive Care Medicine
  • Epidemiology
  • Nephrology
  • Transplantation

Cite this

Sodium bicarbonate is associated with an increased incidence of contrast nephropathy : A retrospective cohort study of 7977 patients at Mayo Clinic. / From, Aaron M.; Bartholmai, Brian Jack; Williams, Amy W.; Cha, Stephen S.; Pflueger, Axel; McDonald, Furman S.

In: Clinical Journal of the American Society of Nephrology, Vol. 3, No. 1, 01.2008, p. 10-18.

Research output: Contribution to journalArticle

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