Final results of last week’s Renal Fellow Network poll:
There seemed to be general agreement that volume expansion with isotonic saline is definitely effective, and many individuals also selected the isotonic saline + N-acetylcysteine combination. Interestingly, only 23% advocated using a sodium bicarbonate-based regimen (6% iv bicarb alone + 17% iv bicarb + oral NAC) despite its superiority as demonstrated in the oft-cited 2004 JAMA paper in which patients were randomized to receive either an iv bicarbonate or an iv saline regimen, and this recent 2009 AJKD meta-analysis of trials involving sodium bicarbonate for the prevention of contrast nephropathy. However it is essential to point out that this remains a controversial topic, and hopefully further RCTs will clarify the issue.
I think the data showing that there is no difference between saline and bicarb is just as compelling…see a recent meta-analysis in cJASN.
Our local nephrologists do saline + IV NAC. Is this not available in your neck of the woods?