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Sodium bicarbonate + saline is an intravenous hydration regimen evaluated for the prevention of contrast-induced acute kidney injury (CI-AKI) in patients undergoing procedures such as coronary angiography. This combination therapy, specifically studied in a randomized controlled trial by the Federal University of São Paulo (NCT01612013), utilizes isotonic saline (0.9% sodium chloride) for volume expansion and a sodium bicarbonate solution to alkalinize the urine. The saline component works by increasing renal blood flow and diluting the concentration of contrast media within the renal tubules. Sodium bicarbonate is hypothesized to mitigate renal damage by raising the pH of the tubular fluid, which may reduce the formation of reactive oxygen species and decrease the direct toxicity of iodinated contrast agents on tubular cells. Despite its theoretical benefits, clinical trials, including the one conducted by the Federal University of São Paulo, have often found that this combination does not provide superior protection against CI-AKI compared to saline hydration alone.
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