PrevenTion of Contrast-inducEd nephroAThy With urinE Alkalinization
Status:
Completed
Trial end date:
2021-05-01
Target enrollment:
Participant gender:
Summary
Intravascular administration of iodinated contrast media is an essential tool for
cardiovascular imaging and percutaneous coronary interventions. Nonetheless, the increasing
incidence of contrast-induced nephropathy (CIN) has become an important and prognostically
relevant problem along with the spreading of diagnostic and interventional procedures. CIN is
largely dependent on oxidative damage and represents a considerable cause of renal failure,
being associated with prolonged hospitalization and significant morbidity/mortality. The most
effective treatment strategy of this serious complication remains prevention, and several
preventive measures have been extensively investigated in the last few years. Pre-procedural
hydration is the best known and mostly accepted strategy. The administration of sodium
bicarbonate (HCO3) has controversial effects, and is likely to be ineffective when the
infused dose is unable to achieve adequate urine alkalinization. Since alkaline pH suppresses
the production of free radicals, increasing urine pH would be an attractive goal for CIN
prevention. In a randomized clinical trial the investigators will test the hypothesis that
urine alkalinization with either oral or i.v. bicarbonate on top of hydration alone is the
main determinant of CIN prevention in a population of patients with moderate or severe
chronic kidney disease scheduled for coronary angiography and/or angioplasty. If the
investigators, demonstrate non-significant differences in urine alkalinization (primary
endpoint) and incidence of CIN (secondary endpoint) between the bicarbonate groups, a
practical implication will be that oral administration is preferable for practical reasons
over the administration of i.v. bicarbonate.