Nonpharmacological Strategies to Prevent Contrast-Induced Acute Kidney Injury
Table 2
Summary of meta-analysis of randomized controlled trials to evaluate the benefit of sodium bicarbonate versus normal saline on prevention of contrast-induced acute kidney injury.
The majority of studies involved subjects undergoing cardiac angiography and using a nonionic low osmolar contrast
The majority of studies involved subjects undergoing cardiac angiography and using a nonionic low osmolar contrast
The majority of studies involved subjects undergoing cardiac angiography and using a nonionic low osmolar contrast
The majority of studies involved subjects undergoing cardiac angiography and using a nonionic low osmolar contrast
The majority of studies involved subjects undergoing cardiac angiography and using a nonionic low osmolar contrast
Results
(i) 3 trials were categorized as large and 12 as small trials. (ii) Among the large trials, the relative risk (RR) was 0.85 (95% CI 0.63 to 1.16) without evidence of heterogeneity. (iii) The pooled RR (95% CI) among the 12 small trials was 0.50 (95% CI 0.27 to 0.93) with significant between-trial heterogeneity. The small trials were more likely to be of lower methodological quality.
The use of sodium bicarbonate revealed an odds ratio (OR) of 0.57 (95% CI 0.38–0.85) for the occurrence of contrast-induced nephropathy.
The use of sodium bicarbonate demonstrated a benefit on the incidence of contrast-induced nephropathy (RR = 0.66, 95% CI 0.45–0.95).
The odds ratio (OR) for the development of contrast nephropathy for sodium bicarbonate versus sodium chloride was 0.33 (95% CI 0.16–0.69).
(i) Preprocedural hydration with sodium bicarbonate was associated with a significant decrease in the rate of CI-AKI (odds ratio [OR] 0.56; 95% CI 0.36–0.86). (ii) Stratified analyses by the type of contrast media suggested the use of sodium bicarbonate lower odds of CI-AKI in studies using low-osmolar contrast media (OR 0.40; 95% CI 0.23–0.71) compared with those using the isoosmolar agents (OR 0.76; 95% CI 0.41–1.43).