title: Current role of sodium bicarbonate-based preprocedural hydration for the prevention of contrast-induced acute kidney injury: a meta-analysis.
abstract: BACKGROUND
  The optimal hydration strategy for prevention of contrast-induced acute kidney injury (AKI) remains unknown. The purpose of this meta-analysis is to compare the effectiveness of normal saline (NS) versus sodium bicarbonate hydration (NaHCO(3)) for prevention of contrast-induced AKI.
  
  
  METHODS
  We performed a meta-analysis of randomized controlled trials that compared saline-based hydration with sodium bicarbonate-based hydration regimen for prophylaxis of contrast-induced AKI. The literature search included MEDLINE, EMBASE, and Cochrane databases (2000 to October 2007); conference proceedings; and bibliographies of retrieved articles. Information was extracted on study design, sample characteristics, and interventions. Random-effects models were used to calculate summary risk ratios for contrast-induced AKI, need for hemodialysis, and death.
  
  
  RESULTS
  Seven trials with 1,307 subjects were included. Preprocedural hydration with sodium bicarbonate was associated with a significant decrease in the rate of contrast-induced AKI (5.96% in the NaHCO(3) arm versus 17.23% in the NS arm, summary risk ratio 0.37, 95% CI 0.18-0.714, P = .005). There was no difference in the rates of postprocedure hemodialysis or death. Formal testing revealed moderate heterogeneity and a strong likelihood of publication bias.
  
  
  CONCLUSIONS
  Although sodium bicarbonate hydration was found to be superior to NS in prevention of contrast-induced AKI, these results are in the context of study heterogeneity and, likely, publication bias. An adequately powered randomized controlled trial is warranted to define the optimal hydration strategy in patients at high risk of contrast-induced AKI who are scheduled to undergo contrast administration.
authors.affiliation: Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI 48109-5853, USA.
authors.forename: Shea E
authors.initials: SE
authors.lastname: Hogan
authors.forename: Phillipe
authors.initials: P
authors.lastname: L'Allier
authors.forename: Stanley
authors.initials: S
authors.lastname: Chetcuti
authors.forename: P Michael
authors.initials: PM
authors.lastname: Grossman
authors.forename: Brahmajee K
authors.initials: BK
authors.lastname: Nallamothu
authors.forename: Claire
authors.initials: C
authors.lastname: Duvernoy
authors.forename: Eric
authors.initials: E
authors.lastname: Bates
authors.forename: Mauro
authors.initials: M
authors.lastname: Moscucci
authors.forename: Hitinder S
authors.initials: HS
authors.lastname: Gurm