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Hydration with sodium bicarbonate for the prevention of contrast-induced nephropathy: a meta-analysis of randomized controlled trials. Clin Nephrol 2010 Oct;74(4):288-96 PMID: 20875381

Pubmed ID

20875381

Abstract

BACKGROUND: Whether hydration with sodium bicarbonate is beneficial for the prevention of contrast-induced nephropathy is uncertain.

METHODS: We conducted a meta-analysis of trials to evaluate the benefit of sodium bicarbonate solutions for the prevention of contrast-induced nephropathy. Our pre-specified criteria were; 1) adult subjects; 2) English literature 3) randomized trials of individuals assigned to a bicarbonate-containing intravenous solution versus an alternate solution; 4) an end-point that included the incidence of contrast-induced nephropathy 5) a uniform contrast agent. Trials in which certain additional prophylactic agents were allowed or administered in a non-standardized, non-stratified manner were ineligible.

RESULTS: Ten randomized comparisons of sodium bicarbonate versus sodium chloride satisfied study criteria (total n = 1,090). The majority of studies involved subjects undergoing cardiac angiography and a nonionic low osmolar contrast agent was used in most instances. Woolf's test showed no evidence of heterogeneity (p = 0.10; I2 = 39%) and there was no publication bias (p = 0.34). The effect size using the exact Mantel-Haenszel-test revealed an odds ratio (OR) of 0.57 (95% CI: 0.38 - 0.85) for the occurrence of contrast-induced nephropathy with the use of sodium bicarbonate. An analysis restricted to studies that employed hydration without additional prophylactic agents favored sodium bicarbonate to a greater extent (OR 0.33:95% CI: 0.17 - 0.62). However, many trials in this arena may not be considered high-quality studies.

CONCLUSION: Though inference should be tempered by trial quality issues, given lack of heterogeneity or publication bias the summary effect of randomized trials balanced in important characteristics favors hydration with sodium bicarbonate for the prevention of contrast-induced nephropathy.

Author List

Trivedi H, Nadella R, Szabo A

Author

Aniko Szabo PhD Associate Professor in the Institute for Health and Equity department at Medical College of Wisconsin




Scopus

2-s2.0-77957664323   27 Citations

MESH terms used to index this publication - Major topics in bold

Acetylcysteine
Contrast Media
Humans
Kidney Diseases
Randomized Controlled Trials as Topic
Sodium Bicarbonate
Sodium Chloride
jenkins-FCD Prod-299 9ef562391eceb2b8f95265c767fbba1ce5a52fd6