A Simple Way to Prevent Kidney Failure

Intravenous sodium bicarbonate does the trick

TUESDAY, May 18, 2004 (HealthDayNews) -- Researchers report an unexpectedly effective and cheap way of preventing the kidney damage that can sometimes be caused by the contrast solutions used with many of the medical scans taken in hospitals.

The solution? A solution of baking soda.

About 5 million times each year, patients have injections of what are called contrast media, chemicals that sharpen the images obtained by CAT scans, arteriograms and a variety of other scans. In perhaps 50,000 of those patients, the contrast media triggers a reaction causing kidney failure that at best results in prolonged hospitalization and at worst is fatal.

"People have tried a number of different things to treat contrast-induced nephropathy, most of which don't work," said Dr. W. Patrick Burgess, an attending physician at the Carolinas Medical Center.

Burgess is the lead author of a report in the May 19 issue of the Journal of the American Medical Association about a treatment that did work and is stunningly simple: "A dollar and a half of intravenous sodium bicarbonate."

As described in the report, the success of the treatment was undeniable. Only one of 59 patients with early warning signs of kidney failure who were given sodium bicarbonate developed nephropathy, compared to eight of 60 patients with the same warning signs who got an infusion or ordinary salt water.

An accompanying editorial by Dr. Glenn M. Chertow of the University of California at San Francisco says that sodium bicarbonate "should now be considered the treatment of choice" for prevention of contrast-induced kidney failure.

The surprising thing about that recommendation is that no one has ever tried sodium bicarbonate before. It has been known that the kidney damage was due to formation of tissue-attacking molecules called free radicals, so treatment has centered on use of drugs such as N-acetylcysteine, which destroys free radicals as they are made.

The sodium bicarbonate treatment was proposed by Burgess on the basis of what he learned in his first career, chemical engineering, which he practiced for four years before entering medical school. Essentially, it is the same treatment used by someone who downs a dose of bicarb to ease an attack of indigestion, Burgess explained.

"All the free radical literature in the world says that the more acid in the blood, the higher the rate of free radical formation," he said. "The presence of acid accentuates the cascade of formation of free radicals."

A normally functioning kidney maintains proper acid-base balance by generating bicarbonate, Burgess said, so the most plausible explanation is that the infusion of sodium bicarbonate helps maintain the necessary balance that prevents the destructive attack of free radicals on delicate kidney structures.

That explanation remains partly speculative, since there is not much in the medical literature on the subject, Burgess said, adding there was only "a little bit that showed it might work.."

More studies will help establish the preventive treatment, the Chertow editorial said, and "such studies would be simple, inexpensive and low risk."

More information

A discussion of what can go wrong with the kidney and what can be done to set it right is given by the National Institute of Diabetes and Digestive and Kidney Diseases.

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