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May 19, 2004

Prevention of Radiocontrast Nephropathy: Back to Basics

Author Affiliations

Author Affiliations: Division of Nephrology, Departments of Medicine, Epidemiology, and Biostatistics, University of California, San Francisco.

JAMA. 2004;291(19):2376-2377. doi:10.1001/jama.291.19.2376

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.