ITL: Physician Reviews of HM-Relevant Research

The Hospitalist. 2012 July;2012(07):

July 31, 2012 | The Hospitalist

Alexander R. Carbo, MD, SFHM ; Jonathan T. Crocker, MD ; Lauren Doctoroff, MD, FHM ; Elizabeth Farrell, MD ; Rebecca Newlin Hutchinson, MD, MPH

Study design: Randomized, open-label, controlled trial.

Setting: Three European medical centers.

Synopsis: The study examined 258 patients with an estimated glomerular filtration rate <60mL/min/1.73m2 undergoing intravenous or intra-arterial contrast procedure. Patients with Class III or IV heart failure were excluded. The remaining patients were randomized to receive one of three regimens: sodium chloride at 1 ml/kg/hr for 12 hours prior to and 12 hours following the procedure; intravenous sodium bicarbonate for one hour prior to and six hours following the procedure; or intravenous and oral sodium bicarbonate 20 minutes prior to the procedure.

The group that received saline had a lower incidence of contrast-induced nephropathy than the bicarbonate groups (1% vs. 9% vs. 10%). The oral bicarbonate strategy was noninferior to the seven-hour intravenous bicarbonate strategy.

The authors postulated that saline should be used for high-risk patients, but that given the overall low incidence of contrast-induced nephropathy, the short-term bicarbonate strategy (intravenous followed by oral) is a viable alternative for low-risk patients.

Bottom line: Sodium chloride is more effective than sodium bicarbonate for preventing contrast-induced nephropathy, but in light of the low incidence, a short course of sodium bicarbonate is a possible convenient alternative for low-risk patients.

Citation: Klima T, Christ A, Marana I, et al. Sodium chloride vs. sodium bicarbonate for the prevention of contrast medium-induced nephropathy: a randomized controlled trial. Eur Heart J. 2012 Jan 19 [Epub ahead of print].

Clinical Shorts

ALBUMIN BENEFITS HIGH-RISK PATIENTS WITH SPONTANEOUS BACTERIAL PERITONITIS

In high-risk patients with elevated bilirubin or BUN and diagnosed with SBP, albumin infusion might improve mortality but is not necessary in low-risk patients.

Citation: Poca M, Concepción M, Casas M, et al. Role of albumin treatment in patients with spontaneous bacterial peritonitis. Clin Gastroenterol Hepatol. 2012;10:309-315.

FIBRATE USE ASSOCIATED WITH INCREASES IN CREATININE

An observational population-based cohort study in Ontario revealed that elderly patients prescribed fibrates were more likely to be hospitalized for increased serum creatinine and undergo nephrology consultation than those prescribed ezetimibe.

Citation: Zhao YY, Weir MA, Manno M, et. al. New fibrate use and acute renal outcomes in elderly adults: a population-based study. Ann Intern Med. 2012;156(8):560-569.