Renal Insufficiency and the Impact of Contrast Agents

Chronic kidney disease (CKD) is a global health burden with a high economic cost to health systems and represents an independent risk factor for cardiovascular disease. Myocardial revascularization in patients with CKD by either percutaneous or surgical approaches is gravated by a higher rate of complications than in patients without CKD. Contrast-associated acute kidney injury represents one of the most common complications in this subset of patients. It was hypothesized that to alkalize the tubular urine with sodium bicarbonate may limit the renal damage induced by the contrast agents by reducing the amount of free radicals pH-dependent. Hemofiltration is expensive, time consuming, logistically cumbersome and associated with significant risks. Its effectiveness compared to other less expensive strategies is not well established so that this treatment modality should be reserved for patients who already have fairly advanced renal insufficiency.