To the Editor: We are concerned about possible confounding in the trial by Dr Brar and colleagues1 reporting that hydration with sodium bicarbonate was not superior to hydration with sodium chloride for the prevention of CIN in patients with moderate to severe chronic kidney disease who were undergoing coronary angiography. Nonsteroidal anti-inflammatory drugs (NSAIDs) are among the medications most frequently prescribed to elderly persons, especially for acute and chronic pain.2 Millions of patients use prescription NSAIDs daily, and half of these patients are older than 60 years and more susceptible to the adverse effects of NSAIDs.3 These medications inhibit the local vasodilatory effects of prostaglandins and may contribute to the effects of nephrotoxic contrast agents.4
Kanbay M, Kasapoglu B, Akcay A. Sodium Bicarbonate vs Sodium Chloride in Preventing Contrast Medium–Induced Nephropathy. JAMA. 2009;301(4):377–380. doi:https://doi.org/10.1001/jama.2009.18
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