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To the Editor: We found some of the results in the study by Dr Merten and colleagues¹ surprising. The change in serum creatinine level after radiographic contrast (mean difference, 0.11 mg/dL; 95% confidence interval [CI], –1.10 to 0.30) was not significant while the change in estimated glomerular filtration rate (GFR) (mean difference, –8.6%; 95% CI, –17.0 to –0.2) was significant. Since in using the Levey formula, serum creatinine is the major determinant in calculating GFR, one might expect the change in creatinine and GFR to be of similar magnitude. We wonder if changes other than in creatinine could explain the calculated GFR change. The Levey formula uses age and sex, which would not change over 2 days, but also uses blood urea nitrogen (BUN) and serum albumin levels. While these values are stable over the long-term, it is possible that the infusion of sodium bicarbonate (NaHCO₃) expanded extracellular fluid . . . [Full Text of this Article]

L. Shavit, MD
itz@szmc.org.il

M. Lifschitz, MD; J. Plaksin, MD; I. N. Slotki, MD
Division of Nephrology
Shaare Zedek Medical Center
Jerusalem, Israel

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