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Sodium bicarbonate-based hydration prevents contrast-induced nephropathy: a meta-analysis.

Meier P, Ko DT, Tamura A, Tamhane U, Gurm HS - BMC Med (2009)

Bottom Line: Former meta-analyses and several recent studies have shown conflicting results regarding the protective effect of sodium bicarbonate.No significant differences in the rates of post-procedure hemodialysis (P = 0.20) or death (P = 0.53) was observed.Sodium bicarbonate-based hydration was found to be superior to normal saline in prevention of contrast-induced nephropathy in this updated meta-analysis.

View Article: PubMed Central - HTML - PubMed

Affiliation: University of Michigan School of Medicine, Ann Arbor, Michigan, USA. pmeier@med.umich.edu

ABSTRACT

Background: Contrast-induced nephropathy is the leading cause of in-hospital acute renal failure. This side effect of contrast agents leads to increased morbidity, mortality, and health costs. Ensuring adequate hydration prior to contrast exposure is highly effective at preventing this complication, although the optimal hydration strategy to prevent contrast-induced nephropathy still remains an unresolved issue. Former meta-analyses and several recent studies have shown conflicting results regarding the protective effect of sodium bicarbonate. The objective of this study was to assess the effectiveness of normal saline versus sodium bicarbonate for prevention of contrast-induced nephropathy.

Methods: The study searched MEDLINE, EMBASE, Cochrane databases, International Pharmaceutical Abstracts database, ISI Web of Science (until 15 December 2008), and conference proceedings for randomized controlled trials that compared normal saline with sodium bicarbonate-based hydration regimen regarding contrast-induced nephropathy. Random-effects models were used to calculate summary odds ratios.

Results: A total of 17 trials including 2,633 subjects were pooled. Pre-procedural hydration with sodium bicarbonate was associated with a significant decrease in the rate of contrast-induced nephropathy (odds ratios 0.52; 95% confidence interval 0.34-0.80, P = 0.003). Number needed to treat to prevent one case of contrast-induced nephropathy was 16 (95% confidence interval 10-34). No significant differences in the rates of post-procedure hemodialysis (P = 0.20) or death (P = 0.53) was observed.

Conclusion: Sodium bicarbonate-based hydration was found to be superior to normal saline in prevention of contrast-induced nephropathy in this updated meta-analysis.

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Forest plot of stratified analysis by studies using iso-osmolar (iodixanol) versus low-osmolar contrast media. Sizes of data markers are proportional to the weight of each study in the meta-analysis. Horizontal bars, 95% confidence interval.
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Figure 4: Forest plot of stratified analysis by studies using iso-osmolar (iodixanol) versus low-osmolar contrast media. Sizes of data markers are proportional to the weight of each study in the meta-analysis. Horizontal bars, 95% confidence interval.

Mentions: Stratified analyses suggested a more pronounced effect of NaHCO3 in the two trials including exclusively patients undergoing emergency procedures [22,24] (OR 0.10; 95% CI 0.02–0.42; P = 0.002) compared with patients undergoing elective procedures (OR 0.63; 95% CI 0.43–0.92; P = 0.017) (Figure 3). Similarly, stratified analysis by the type of contrast medium used suggested lower odds of CIN with NaHCO3 in studies using low-osmolar contrast media [11,16,19,20,22-25,27] (OR 0.29; 95% CI 0.15–0.57) compared with those using the iso-osmolar agent iodixanol [8,9,15,18] (OR 0.73; 95% CI 0.32–1.64, P = 0.441) (Figure 4).


Sodium bicarbonate-based hydration prevents contrast-induced nephropathy: a meta-analysis.

Meier P, Ko DT, Tamura A, Tamhane U, Gurm HS - BMC Med (2009)

Forest plot of stratified analysis by studies using iso-osmolar (iodixanol) versus low-osmolar contrast media. Sizes of data markers are proportional to the weight of each study in the meta-analysis. Horizontal bars, 95% confidence interval.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2693108&req=5

Figure 4: Forest plot of stratified analysis by studies using iso-osmolar (iodixanol) versus low-osmolar contrast media. Sizes of data markers are proportional to the weight of each study in the meta-analysis. Horizontal bars, 95% confidence interval.
Mentions: Stratified analyses suggested a more pronounced effect of NaHCO3 in the two trials including exclusively patients undergoing emergency procedures [22,24] (OR 0.10; 95% CI 0.02–0.42; P = 0.002) compared with patients undergoing elective procedures (OR 0.63; 95% CI 0.43–0.92; P = 0.017) (Figure 3). Similarly, stratified analysis by the type of contrast medium used suggested lower odds of CIN with NaHCO3 in studies using low-osmolar contrast media [11,16,19,20,22-25,27] (OR 0.29; 95% CI 0.15–0.57) compared with those using the iso-osmolar agent iodixanol [8,9,15,18] (OR 0.73; 95% CI 0.32–1.64, P = 0.441) (Figure 4).

Bottom Line: Former meta-analyses and several recent studies have shown conflicting results regarding the protective effect of sodium bicarbonate.No significant differences in the rates of post-procedure hemodialysis (P = 0.20) or death (P = 0.53) was observed.Sodium bicarbonate-based hydration was found to be superior to normal saline in prevention of contrast-induced nephropathy in this updated meta-analysis.

View Article: PubMed Central - HTML - PubMed

Affiliation: University of Michigan School of Medicine, Ann Arbor, Michigan, USA. pmeier@med.umich.edu

ABSTRACT

Background: Contrast-induced nephropathy is the leading cause of in-hospital acute renal failure. This side effect of contrast agents leads to increased morbidity, mortality, and health costs. Ensuring adequate hydration prior to contrast exposure is highly effective at preventing this complication, although the optimal hydration strategy to prevent contrast-induced nephropathy still remains an unresolved issue. Former meta-analyses and several recent studies have shown conflicting results regarding the protective effect of sodium bicarbonate. The objective of this study was to assess the effectiveness of normal saline versus sodium bicarbonate for prevention of contrast-induced nephropathy.

Methods: The study searched MEDLINE, EMBASE, Cochrane databases, International Pharmaceutical Abstracts database, ISI Web of Science (until 15 December 2008), and conference proceedings for randomized controlled trials that compared normal saline with sodium bicarbonate-based hydration regimen regarding contrast-induced nephropathy. Random-effects models were used to calculate summary odds ratios.

Results: A total of 17 trials including 2,633 subjects were pooled. Pre-procedural hydration with sodium bicarbonate was associated with a significant decrease in the rate of contrast-induced nephropathy (odds ratios 0.52; 95% confidence interval 0.34-0.80, P = 0.003). Number needed to treat to prevent one case of contrast-induced nephropathy was 16 (95% confidence interval 10-34). No significant differences in the rates of post-procedure hemodialysis (P = 0.20) or death (P = 0.53) was observed.

Conclusion: Sodium bicarbonate-based hydration was found to be superior to normal saline in prevention of contrast-induced nephropathy in this updated meta-analysis.

Show MeSH
Related in: MedlinePlus