Preventing contrast-induced nephropathy: a basic solution.
This is a good quality study that demonstrates a dramatic decrease in the incidence of contrast nephropathy with the use of sodium bicarbonate infusion prior to contrast administration. However, this study does have some shortcomings. The small sample size resulted in relatively wide confidence intervals and made the generally low attrition rate more significant. The data was not analyzed on an intention-to-treat basis, which could lead to an overestimation of the benefits of bicarbonate. None of the patients developing contrast nephropathy went on to require dialysis. The authors note that the length of hospital stay was adversely affected by the development of contrast nephropathy, although they do not report the extent to which this occurred and whether or not the increase in hospital days was significant. This study did not include the use of N-acetylcysteine, which has been shown to decrease the risk of contrast-induced nephropathy in some studies.