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.

	Brar et al. (2009) [26]	Trivedi et al. (2010) [27]	Hoste et al. (2010) [28]	Kunadian et al. (2011) [29]	Jang et al. (2012) [30]
Inclusion study period	1966–November 2008	1950–May 2009	1950–February 20, 2009	Inception–September 2008	2001–January 31, 2012
Number of trials and included patients	14 trials (2,290 patients)	10 trials (1,090 patients)	18 trials (3,055 patients)	7 trials (1,734 patients)	19 trials (3,609 patients)
Setting and type of 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	The majority of studies involved subjects undergoing cardiac angiography and using a nonionic low osmolar contrast
Results	(i) 3 trials were categorized as large (𝑛=1145) and 12 as small (𝑛=1145) 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).