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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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Related in: MedlinePlus

Funnel plot of contrast-induced nephropathy (with estimated unpublished studies). Trials are depicted by circles with the random-effects log odds ratio shown along the horizontal axis and precision in estimating this effect (reciprocal standard error) along the vertical axis. The Trim and Fill method was used to calculate the true center of the funnel (indicated by the vertical line) after filling in estimates of unpublished studies (depicted with black dots). The empty diamond indicates the original confidence intervals of the log odds ratio; the black diamond indicates the corresponding values when the additional imputed studies are also considered.
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Figure 8: Funnel plot of contrast-induced nephropathy (with estimated unpublished studies). Trials are depicted by circles with the random-effects log odds ratio shown along the horizontal axis and precision in estimating this effect (reciprocal standard error) along the vertical axis. The Trim and Fill method was used to calculate the true center of the funnel (indicated by the vertical line) after filling in estimates of unpublished studies (depicted with black dots). The empty diamond indicates the original confidence intervals of the log odds ratio; the black diamond indicates the corresponding values when the additional imputed studies are also considered.

Mentions: Assessment of publication bias using a funnel plot indicated slight asymmetry (Figure 8), and this was confirmed on formal testing (rank order correlation or Kendall τ of -0.324, one-tailed P value of 0.038, two-tailed P = 0.077, and Egger's test intercept of -1.71, 95% CI of -3.02 to -0.40 with one-tailed P value of 0.007, two-tailed P = 0.014). These tests suggest that the results of this meta-analysis were influenced by a larger treatment effect seen in smaller studies.


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

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

Funnel plot of contrast-induced nephropathy (with estimated unpublished studies). Trials are depicted by circles with the random-effects log odds ratio shown along the horizontal axis and precision in estimating this effect (reciprocal standard error) along the vertical axis. The Trim and Fill method was used to calculate the true center of the funnel (indicated by the vertical line) after filling in estimates of unpublished studies (depicted with black dots). The empty diamond indicates the original confidence intervals of the log odds ratio; the black diamond indicates the corresponding values when the additional imputed studies are also considered.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 8: Funnel plot of contrast-induced nephropathy (with estimated unpublished studies). Trials are depicted by circles with the random-effects log odds ratio shown along the horizontal axis and precision in estimating this effect (reciprocal standard error) along the vertical axis. The Trim and Fill method was used to calculate the true center of the funnel (indicated by the vertical line) after filling in estimates of unpublished studies (depicted with black dots). The empty diamond indicates the original confidence intervals of the log odds ratio; the black diamond indicates the corresponding values when the additional imputed studies are also considered.
Mentions: Assessment of publication bias using a funnel plot indicated slight asymmetry (Figure 8), and this was confirmed on formal testing (rank order correlation or Kendall τ of -0.324, one-tailed P value of 0.038, two-tailed P = 0.077, and Egger's test intercept of -1.71, 95% CI of -3.02 to -0.40 with one-tailed P value of 0.007, two-tailed P = 0.014). These tests suggest that the results of this meta-analysis were influenced by a larger treatment effect seen in smaller studies.

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