Home > Journal Club > Journal Club 30 October 2013

Journal Club 30 October 2013


Prevention of contrast-induced nephropathy with Na/K citrate





Contrast-induced nephropathy (CIN) is a frequent complication of many radiological procedures involving the application
of contrast media. It represents a significant health problem that causes the increase in mortality, morbidity,
and medical costs. For the prevention of CIN, a number of methods have been proposed to be effective. Among
them, alkalinization of urine takes an important place. Although the Na/K citrate is a well-known agent for urine alkalinization,
it has not been studied in the prevention of CIN.

Methods and results

Two hundred and two patients who underwent coronary angiography were included in the study. They were randomized
into groups receiving the drug Na/K citrate per os and to the control group. Serum creatinine and glomerular
filtration rate were determined in all patients immediately before coronary angiography, and 48 h after the
procedure. CIN criteria were a creatinine increase of .25%, reduction in the glomerular filtration rate by .25%,
or an increase in serum creatinine of .44 mmol/L. The incidence of CIN in the group receiving Na/K citrate was
significantly lower when compared with the control group (4% compared with 20%, P ¼ 0.0001). Patients who
had a urine pH ,6 had a more than ten-fold higher incidence of contrast nephropathy compared with patients
whose urine pH was .6.


Alkalinization of urine using the Na/K citrate may reduce the incidence of CIN.

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