Author Affiliations: Division of Nephrology, Departments of Medicine, Epidemiology, and Biostatistics, University of California, San Francisco.
In this issue of THE JOURNAL, the study by Merten and colleagues1 provides important data on radiocontrast nephropathy,
an ongoing focus of research in acute kidney disease. In 119 patients with
a baseline serum creatinine concentration of at least 1.1 mg/dL, the authors
compared 0.9% sodium chloride with an isotonic solution of sodium bicarbonate,
administered at rates of 3 mL/kg per hour for 1 hour before and 1 mL/kg per
hour for 6 hours after radiocontrast exposure. Radiocontrast nephropathy,
defined as an increase of 25% or more in serum creatinine, developed in less
than 2% of patients receiving sodium bicarbonate compared with 14% in the
group receiving saline. The 2% rate in the intervention group was confirmed
in an open-label follow-up registry. The authors postulated that the effects
of bicarbonate on urine pH might reduce oxygen free-radical formation, thereby
reducing radiocontrast-induced injury.
Chertow GM. Prevention of Radiocontrast NephropathyBack to Basics. JAMA. 2004;291(19):2376-2377. doi:10.1001/jama.291.19.2376