In patients with chronic kidney disease undergoing angiography, periprocedural intravenous isotonic sodium bicarbonate showed no benefit over intravenous isotonic sodium chloride for the risk of major adverse kidney events, death, or acute kidney injury, according to results of the PRESERVE trial presented at American Heart Association’s Scientific Sessions 2017 and simultaneously published in the New England Journal of Medicine.

Steven D. Weisbord, MD, et al., looked at 5,177 patients at high risk for renal complications who were scheduled for angiography to receive intravenous 1.26% sodium bicarbonate or intravenous 0.9% sodium chloride and five days of oral acetylcysteine or oral placebo.

The authors explain that the trial was stopped after a prespecified interim analysis. Results showed that there was no interaction between sodium bicarbonate and acetylcysteine with respect to the primary endpoint (P=0.33)—a composite of death, the need for dialysis, or a persistent increase of at least 50% from baseline in the serum creatinine level at 90 days. In addition, the authors found no benefit for the oral administration of acetylcysteine over placebo.

The authors conclude that their findings "support the strong likelihood that these interventions are not clinically effective in preventing acute kidney injury or longer-term adverse outcomes after angiography."