1. Current role of sodium bicarbonate-based preprocedural hydration for the prevention of contrast-induced acute kidney injury: a meta-analysis
- Author
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Brahmajee K. Nallamothu, Hitinder S. Gurm, Stanley Chetcuti, Mauro Moscucci, P. Michael Grossman, Phillipe L'Allier, Shea Elizabeth Hogan, Eric R. Bates, and Claire S. Duvernoy
- Subjects
Male ,medicine.medical_specialty ,medicine.medical_treatment ,Contrast Media ,Context (language use) ,Sodium Chloride ,law.invention ,chemistry.chemical_compound ,Randomized controlled trial ,law ,medicine ,Odds Ratio ,Humans ,Aged ,Randomized Controlled Trials as Topic ,Sodium bicarbonate ,business.industry ,Acute kidney injury ,Publication bias ,medicine.disease ,Surgery ,Solutions ,Sodium Bicarbonate ,chemistry ,Anesthesia ,Relative risk ,Acute Disease ,Fluid Therapy ,Female ,Kidney Diseases ,Hemodialysis ,Cardiology and Cardiovascular Medicine ,business ,Kidney disease - Abstract
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 (NaHCO 3 ) 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 NaHCO 3 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.
- Published
- 2008