Sodium bicarbonate therapy for prevention of contrast-induced nephropathy: a systematic review and meta-analysis.
BACKGROUND
Optimal hydration measures to prevent contrast-induced nephropathy are controversial.


METHODS
We conducted a systematic review and meta-analysis using the MEDLINE database (1966 to January 2008), EMBASE (January 2008), and abstracts from conference proceedings.


METHODS
Adult patients undergoing contrast procedures.


METHODS
Randomized controlled trials comparing intravenous hydration with sodium bicarbonate with hydration with intravenous normal saline for prevention of contrast-induced nephropathy.


METHODS
Hydration with intravenous sodium bicarbonate with or without N-acetylcysteine versus hydration with normal saline with or without N-acetylcysteine.


RESULTS
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analysis limited to published trials showed similar results (OR, 0.26; 95% CI, 0.10 to 0.64; I2 = 63.3%), whereas unpublished studies showed a nonsignificant decrease (OR, 0.85; 95% CI, 0.46 to 1.57; I2 = 25.9%) in risk of contrast-induced nephropathy.


CONCLUSIONS
Publication bias and heterogeneity.


CONCLUSIONS
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.
Navaneethan
Sankar D
SD
Department of Nephrology and Hypertension, Cleveland Clinic, Cleveland, OH 44195, USA. navanes@ccf.org
Singh
Sonal
S
Appasamy
Suresh
S
Wing
Richard E
RE
Sehgal
Ashwini R
AR
D000328:Adult; D003287:Contrast Media / Q000009:adverse effects*; D006801:Humans; D007262:Infusions, Intravenous; D007674:Kidney Diseases / Q000139:chemically induced* / Q000517:prevention & control*; D016032:Randomized Controlled Trials as Topic; D017693:Sodium Bicarbonate / Q000008:administration & dosage / Q000627:therapeutic use*; D012965:Sodium Chloride / Q000008:administration & dosage / Q000627:therapeutic use; D016896:Treatment Outcome
D003287:Contrast Media; D012965:Sodium Chloride; D017693:Sodium Bicarbonate