Use of sodium bicarbonate instead of saline for hydration before and 4 hours after coronary angiography may reduce the risk of death in patients.

This is evidenced by the data of a new randomized trial.

In a study that was prematurely terminated, all-cause mortality at 6 months was 3-fold lower in patients who received sodium bicarbonate for hydration prior to coronary angiography (3.2% versus 10.8%; P\u003d0.021).

At the same time, peripheral angiography did not reveal a similar difference in outcomes.. These results were released by Dr. Richard Solomon, a research fellow at the University of Vermont at Burlington..

Unlike other studies, this study did not find an effect of the mode of hydration on the incidence of contrast-induced nephropathy.. Dr. Solomon at a meeting of Transcatheter Cardiovascular Therapeutics stated about the " The possible mechanism remains unclear, and today scientists can only put forward hypotheses. But the fact remains that sodium bicarbonate solution is preferable to normal saline for hydration before coronary angiography..

Data from other clinical studies and observational studies have found an association between acute kidney injury (AKI) and worse long-term clinical outcomes, but this study did not find an association between fluid choice and risk of nephropathy. This was stated in a letter to one of the American publications by Dr. Somjot Brar from the Kaiser Permanente Medical Center (Los Angeles), who is skeptical about the results of the work.. He called the BOSS study, the results of which Dr. Solomon used, not quite suitable for evaluating this endpoint..

Dr. Solomon presented the results of the BOSS study comparing the efficacy of sodium bicarbonate and saline in preventing death, need for renal replacement, and progressive renal failure over 6 months in patients with an estimated glomerular filtration rate of 44 ml/min/1.73m2 on angiography.

Both agents were administered as a bolus of 5 ml/kg 1 hour before the procedure and then slowly at a dose of 1.5 ml/kg/hour for 4 hours after angiography.

The planned sample size was 536 patients, but only 391 were randomized.. Most (80%) underwent coronary angiography, the rest - peripheral angiography. At 4 months, there was no significant difference in the primary endpoint (14.8% in the bicarbonate group vs. 16.3% in the saline group, P\u003dNS). This is in line with some of the larger studies done before, including one of Dr. Brar's..

Mortality, however, was lower in the bicarbonate group, but the difference was only significant with coronary angiography..

“The incidence of contrast-induced nephropathy did not differ between the two groups, which is very important because many people, including myself, previously believed that the difference in outcomes in these trials depends on kidney protection.. And here, there was no association between effects on the kidneys and overall mortality, ”says Dr. Solomon.

medbe. en.