Usefulness of Sodium Bicarbonate for the Prevention of Contrast-Induced Nephropathy in Patients Undergoing Cardiac Resynchronization Therapy

Autores de IIS La Fe

• Pau Alonso Fernández

  Autor

• Ana Garcia Orts

  Autor

• Samuel Reina De La Torre

  Autor

• Joaquín Osca Asensi

  Autor

• Óscar Cano Pérez

  Autor

• Ana Andrés Lahuerta

  Autor

• María José Sancho-Tello De Carranza

  Autor

• Laura Martinez Barbarroja

  Autor

Participantes ajenos a IIS La Fe

• Sanz, J
• Jimenez, S

Grupos

• Regeneración y Trasplante Cardíaco

  

  Leader

  Pilar Sepúlveda Sanchis

Abstract

The use of contrast media during cardiac resynchronization therapy (CRT) devices implantation is associated with the risk of contrast-induced nephropathy (CIN). The aim of this study was to evaluate the possible beneficial role of periprocedural intravenous volume expansion with isotonic saline and sodium bicarbonate solution in patients who undergo CRT implantation. Eligible patients were randomly assigned in a 1:1 ratio to receive hydration plus one-sixth molar sodium bicarbonate (study group) or not (control group). Primary end point was CIN incidence. Secondary end points were (1) a combined end point of death, heart transplantation, or hospitalization for heart failure at 12 months, (2) incidence of death, and (3) the need for renal replacement therapy at 12 months. Final analysis was performed with 93 patients. In the hydration group CIN incidence was significantly reduced related to control group (0% vs 11%, p = 0.02). There was a trend to reduce the combined end point in hydration group (12.5% vs 22%, p = 0.14). Finally, CIN incidence was related to a higher 12 months mortality (25% vs 7%, p = 0.03). In conclusion, CIN incidence was 11% in a nonselected population of patients receiving a CRT device. CIN appearance could be reduced by using a hydration protocol based on sodium bicarbonate and isotonic saline. (C) 2017 Elsevier Inc. All rights reserved.

Keywords

• ACUTE KIDNEY INJURY; RENAL-FUNCTION; IMPLANTATION; HYDRATION; TRIAL; CRT