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To the Editor: In their randomized trial comparing sodium bicarbonate vs sodium chloride for prevention of contrast medium–induced nephropathy (CIN), Dr Brar and colleagues¹ used a lower dose of bicarbonate than described in other studies^2-4 and found that this lower dose of bicarbonate was inadequate to significantly reduce CIN. Their study did not document urine pH as was done in other studies.^2-3,5 The bicarbonate concentration in their study was 130 mEq/L compared with 154 mEq/L in the other studies. The administered dose of bicarbonate anion was higher in the studies by Merten et al² (by 18%), Ozcan et al³ (by 58%), and Recio-Mayoral et al⁴ (by 202%). The higher doses would likely result in a higher urine pH, although the bicarbonate effect on urine pH is nonlinear.

The hypothesis set forth in the original bicarbonate hydration article² referred to the establishment of a relatively neutral pH in the medullary portion . . . [Full Text of this Article]

William Burgess, MD, PhD
patburgess@mdsci.com

Gregory J. Merten, MD; Robert A. Rittase, PharmD
Department of Internal Medicine
Carolinas Medical Center
Charlotte, North Carolina

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