Sodium bicarbonate therapy for prevention of contrast-induced nephropathy: a systematic review and meta-analysis
SD Navaneethan, S Singh, S Appasamy… - American journal of …, 2009 - Elsevier
SD Navaneethan, S Singh, S Appasamy, RE Wing, AR Sehgal
American journal of kidney diseases, 2009•ElsevierBACKGROUND: Optimal hydration measures to prevent contrast-induced nephropathy are
controversial. STUDY DESIGN: We conducted a systematic review and meta-analysis using
the MEDLINE database (1966 to January 2008), EMBASE (January 2008), and abstracts
from conference proceedings. SETTING & POPULATION: Adult patients undergoing contrast
procedures. SELECTION CRITERIA FOR STUDIES: Randomized controlled trials
comparing intravenous hydration with sodium bicarbonate with hydration with intravenous …
controversial. STUDY DESIGN: We conducted a systematic review and meta-analysis using
the MEDLINE database (1966 to January 2008), EMBASE (January 2008), and abstracts
from conference proceedings. SETTING & POPULATION: Adult patients undergoing contrast
procedures. SELECTION CRITERIA FOR STUDIES: Randomized controlled trials
comparing intravenous hydration with sodium bicarbonate with hydration with intravenous …
BACKGROUND
Optimal hydration measures to prevent contrast-induced nephropathy are controversial.
STUDY DESIGN
We conducted a systematic review and meta-analysis using the MEDLINE database (1966 to January 2008), EMBASE (January 2008), and abstracts from conference proceedings.
SETTING & POPULATION
Adult patients undergoing contrast procedures.
SELECTION CRITERIA FOR STUDIES
Randomized controlled trials comparing intravenous hydration with sodium bicarbonate with hydration with intravenous normal saline for prevention of contrast-induced nephropathy.
INTERVENTION
Hydration with intravenous sodium bicarbonate with or without N-acetylcysteine versus hydration with normal saline with or without N-acetylcysteine.
OUTCOMES
Contrast-induced nephropathy, need for renal replacement therapy, and worsening of heart failure.
RESULTS
Twelve trials (1,854 participants) were included. Sodium bicarbonate significantly decreased the risk of contrast-induced nephropathy (12 trials, 1,652 patients; odds ratio [OR], 0.46; 95% confidence interval [CI], 0.26 to 0.82; I2 = 55.9%) without a significant difference in need for renal replacement therapy (9 trials, 1,215 patients; OR, 0.50; 95% CI, 0.16 to 1.53; I2 = 0%), in-hospital mortality (11 trials, 1,640 patients; OR, 0.51; 95% CI, 0.15 to 1.69), or congestive heart failure compared with controls. Similar results were seen for the risk of contrast-induced nephropathy when sodium bicarbonate was compared with normal saline alone (OR, 0.39; 95% CI, 0.20 to 0.77), but not when sodium bicarbonate/N-acetylcysteine combination was compared with N-acetylcysteine/normal saline combination (OR, 0.68; 95% CI, 0.34 to 1.37). A subgroup analysis limited to published trials showed similar results (OR, 0.26; 95% CI, 0.10 to 0.64; I2 = 63.3%), whereas unpublished studies showed a nonsignificant decrease (OR, 0.85; 95% CI, 0.46 to 1.57; I2 = 25.9%) in risk of contrast-induced nephropathy.
LIMITATION
Publication bias and heterogeneity.
CONCLUSION
Hydration with sodium bicarbonate decreases the incidence of contrast-induced nephropathy in comparison to hydration with normal saline without a significant difference in need for renal replacement therapy and in-hospital mortality. Larger studies analyzing patient-centered outcomes are needed.
Elsevier