Oral hydration and alkalinization is noninferior to intravenous therapy for prevention of contrast-induced nephropathy in patients with chronic kidney disease.
Contrast-induced nephropathy (CIN) is the third leading cause of all cases of hospital-acquired renal failure and contributes to poorer outcomes; in particular, length of hospital stay, fiveand threefold increase in mortality at hospital discharge and at 1 year, and potential dialysis that adds to further reduced outcomes.1–4 Of concern, 14.5% of patients undergoing cardiac catheterization develop CIN and reports have illustrated 50% incidence in high-risk patients; therefore, accurate risk stratification and management are necessary.1,3 Until novel contrast agents become available, the mainstay of CIN management is prevention. Current prevention strategies have focused on renal vasodilators including fenoldapam, low-dose dopamine, calcium-channel antagonists, atrial natriuretic peptide, N-acetylcysteine (NAC), and adenosine antagonists; however, these have not proved superior to preand postprocedure intravenous saline hydration.5–8 A recent study illustrated 11.9% reduced incidence of CIN in patients treated with intravenous saline and intravenous sodium bicarbonate versus intravenous saline alone; however, the protocol involved 8 hours of perioperative intravenous therapy.9 Although prevention