Sodium bicarbonate prophylactic therapy in the prevention of contrast-induced nephropathy in patients admitted to the intensive care unit of a teaching hospital: a retrospective cohort studyReport as inadecuate




Sodium bicarbonate prophylactic therapy in the prevention of contrast-induced nephropathy in patients admitted to the intensive care unit of a teaching hospital: a retrospective cohort study - Download this document for free, or read online. Document in PDF available to download.

Journal of Intensive Care

, 4:5

First Online: 12 January 2016Received: 23 September 2015Accepted: 06 January 2016

Abstract

BackgroundIntravenously administered iodine-containing contrast medium CM is associated with the development of contrast-induced nephropathy CIN. Data on the effectiveness of sodium bicarbonate therapy in the prevention of CIN are controversial. Furthermore, the incidence of and risk factors for CIN in intensive care unit ICU patients are poorly defined. We investigated the effectiveness of sodium bicarbonate prophylaxis and the incidence of and risk factors for CIN in a heterogeneous ICU population.

MethodsThis retrospective cohort study included patients admitted to the ICU in 2009–2011 who received CM for computed tomography CT.

ResultsTwo hundred eleven CT scans with CM, performed in 170 patients, were included in the study. Contrast prophylaxis with sodium bicarbonate was administered in 48 of the 211 cases. CIN developed in 19 of the 48 cases receiving prophylaxis and in 39 of 163 cases not receiving prophylaxis p = 0.03. In 115 CTs performed in patients with a glomerular filtration rate GFR >60 mL-min, prophylaxis was administered 15 times 13 % and no prophylaxis was administered 100 times 87 %. CIN developed in 12 and 13 % of these cases, respectively NS. In 96 CTs in patients with a GFR <60 mL-min, 17 of 33 51.5 % cases receiving prophylaxis developed CIN and 27 of 63 42.9 % cases not receiving prophylaxis developed CIN NS. Prophylactic sodium bicarbonate therapy did not prevent CIN in our patients, irrespective of pre-existing renal failure. Pre-existing renal impairment odds ratio 4.41, an elevated Acute Physiology and Chronic Health Evaluation APACHE IV score odds ratio 1.02, and higher haemoglobin levels odds ratio 0.64 were significant and independent risk factors associated with the development of CIN.

ConclusionsProphylactic isotonic sodium bicarbonate was not associated with a decreased incidence of CIN in ICU patients. Current sodium bicarbonate prophylaxis guidelines cannot be generalized to a heterogeneous ICU population. Pre-existing renal impairment was associated with the highest CIN risk.

KeywordsContrast-induced nephropathy Contrast-induced AKI Prophylactic therapy ICU AbbreviationsAKIacute kidney injury

APACHEAcute Physiology and Chronic Health Evaluation

CI-AKIcontrast-induced acute kidney injury

CINcontrast-induced nephropathy

CMcontrast media

GFRglomerular filtration rate

ICUintensive care unit

KDIGOKidney Disease-Improving Global Outcomes

MODSmultiple organ dysfunction syndrome

RRTrenal replacement therapy

sCrserum creatinine

SOFASequential Organ Failure Assessment

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Author: Nicole Lefel - Loes Janssen - Jos le Noble - Norbert Foudraine

Source: https://link.springer.com/







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