What is the role of bicarbonate therapy in the prevention of contrast-induced nephropathy (CIN)?

Updated: Feb 21, 2020
  • Author: Anita Basu, MD, FACP; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Bicarbonate therapy alkalinizes the renal tubular fluid and thus prevents free radical injury. In the Harber-Weiss reaction, which is activated in an acidic environment, hydrogen peroxide and an oxygen ion (from superoxide) react to form a hydroxide ion, all agents of free radical injury. Bicarbonate, by alkalinizing the environment, slows down that reaction. It also scavenges reactive oxygen species (ROS) from nitric oxide, such as peroxynitrite.

Bicarbonate protocols most often include infusion of sodium bicarbonate at the rate of 3 mL/kg/hour an hour before the procedure, continued at 1 mL/kg/hour for 6 hours afterward. Some investigators have used 1 mL/kg/hour for 24 hours, starting 12 hours before the procedure. The exact duration, however, remains a matter of debate. Hydration with sodium bicarbonate has been found by some researchers to be more protective than normal saline alone.

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