Bicarbonate Physician Memo

To: Physicians and Clinics
From: Myron Pozniak, MD and Bryan Becker, MD
Date: October 3, 2006
Re: Bicarbonate prophylaxis for contrast induced nephrotoxicity (CIN)

As you may know, prevention of contrast induced nephrotoxicity (CIN) has been one of the National Quality Forum (NQF) 30 safe practices. Several methods of preventing (CIN) have been proposed in the recent literature. An interdisciplinary committee of nurses, pharmacists, physicians, and other key personnel at University Hospital reviewed these. We adapted a protocol comprised of hydration with D5W plus sodium bicarbonate. A study focused on inpatients is underway examining the efficacy of this therapy, recovery period, and overall impact on acute kidney injury.

Radiology has started receiving requests for hydration with bicarbonate for outpatient imaging studies. Radiology is working towards providing this service, but currently we are unable to do so for this patient population. Recovery space and extra monitoring capacity including personnel will be required to accomplish this. We hope to offer this in the future, pending the results of our quality and data assessment from the above study.

If you believe your patient would benefit from D5W plus sodium bicarbonate as a prophylactic therapy prior to contrast administration, we can make the protocol available to you. We urge you to arrange for this treatment to be implemented through your office or clinic.

We remind you that any potential benefits of this protocol are currently being assessed. In the best interests of patient care and patient safety, please do not hesitate to consult one of our kidney doctors or discuss with one of our radiologists your patient’s situation.