Elsevier

American Heart Journal

Volume 156, Issue 3, September 2008, Pages 414-421
American Heart Journal

Curriculum in Cardiology
Current role of sodium bicarbonate–based preprocedural hydration for the prevention of contrast-induced acute kidney injury: A meta-analysis

https://doi.org/10.1016/j.ahj.2008.05.014Get rights and content

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 (NaHCO3) 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 NaHCO3 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.

Section snippets

Data sources and searches

Articles from January 1990 through October 2007 were identified using PubMed, MEDLINE, the Cochrane Central Register of Controlled Trials, International Pharmaceutical Abstracts database, and ISI Web of Knowledge. Internet-based sources of information, including www.tctmd.com and www.theheart.org, were also searched. Published abstracts were reviewed from the Proceedings of the Society for Cardiovascular Angiography and Interventions' 30th Annual Scientific Sessions, the American College of

Results

A total of 153 articles were reviewed, and 5 satisfied the predetermined inclusion criteria (Figure 1).20, 21, 22, 23, 24 One study by Schmidt et al25 was excluded because it was a retrospective trial. Two of the studies have not been published in peer-reviewed literature but were presented at the American College of Cardiology 2007 Scientific Session12 and the Transcatheter Therapeutics 2007 meeting26 and are published in abstract form. One study randomized patients to 3 arms: sodium

Discussion

In this meta-analysis of 7 RCTs, we found that preprocedural hydration with sodium bicarbonate significantly reduces the incidence of contrast-induced AKI compared with hydration with NS without decreasing the incidence of death or need for HD. There is, however, concern that these results are strongly influenced by publication bias, indicating the need for a large definitive RCT.

The health care implications of contrast-induced AKI cannot be overemphasized given its effects on patient morbidity

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