BioMed Research International / 2014 / Article / Tab 2

Review Article

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 period1966–November 20081950–May 20091950–February 20, 2009Inception–September 20082001–January 31, 2012

Number of trials and included patients14 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 contrastThe 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 contrastThe majority of studies involved subjects undergoing cardiac angiography and using a nonionic low osmolar contrastThe majority of studies involved subjects undergoing cardiac angiography and using a nonionic low osmolar contrastThe 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).