Current Status of Sodium Bicarbonate in Coronary Angiography: An Updated Comprehensive Meta-Analysis and Systematic Review

Table 1

Demographic data of included studies.

Author			Mean age (years)		Male (%)		Regimen	Contrast media	Mean baseline sCr
	SB	SC	SB	SC	SB	SC
Sodium bicarbonate versus saline
Boucek et al. [13]	61	59	63	67	75.4	74.5	SB solution was produced by adding 154 mL of 8.4% NaHCO3 to 846 mL of 5% glucose. 1 h immediately before (at the rate of 3 mL/kg BW/h limited the maximal amount 330 mL and for 6 h following the intervention	Nonionic low-osmolar contrast medium	119 micromol per litter
Brar et al. [14]	175	178	71	71	62	65	Infusion was begun 1 h prior to the start of contrast administration at 3 mL/kg for 1 h and decreased to 1.5 mL/kg per h during the procedure and for 4 h following completion of the procedure	Nonionic low-osmolar contrast medium	1.5 mg/dL
Alessandri et al. [19]	138	158	64	65	66.6	67.7	160 mEq of NaHCO3 in 350 mL of 5% glucose solution 2 mL/kg/h since two hours before the administration of contrast medium. The infusion prolonged for the following six hours after the procedure with an infusion rate of 1 mL/kg/h	Nonionic low-osmolality contrast medium	1.5 mg/dL
REINFORCE trial [15]	71	74	70.1	72.7	74.6	81	154 mEq of 1000 mEq/L of SB in 5% dextrose solution, prepared at the hospital pharmacy by adding 154 mL of 1000 mEq of SB to 846 mL of 5% dextrose solution and adjusting the dextrose concentration to 4.23%. Fluids were administrated IV at the rate of 2 mL/kg of body weight per hour for 2 h before, at the rate of 1 mL/kg of body weight per hour during, and 6 h after administration of contrast medium	Nonionic iso-osmolar contrast medium	1.6
Yang et al. [20]	159	161	58.7	59.6	52.8	53.4	SB intravenously infused with 1.5% SB solution at the rate of 1.5 mL/kg/h 6 h before the application of the contrast agent. After the contrast exposure was applied the 1.5% SB infusion was continued for 6 h.	Nonionic low-osmolality contrast medium	70 micromol per litter
Vasheghani-Farahani et al. [21]	36	36	61.4	62.7	77.7	80.5	75 mL of 8.4% SB to 1 liter of 0.45% SC. Intravenous bolus was given at the rate of 3 mL/kg for 1 h immediately before contrast injection, followed by an infusion of 1 mg/kg per hours for 6 h after the procedure	Low-osmolar contrast medium iohexol	1.7
Vasheghani-Farahani et al. [16]	135	130	62.9	63.8	91.4	81.5	75 mL of 8.4% SB to 1 liter of 0.45% SC. Intravenous bolus was given at the rate of 3 mL/kg for 1 h immediately before contrast injection, followed by an infusion of 1 mg/kg per hours for 6 h after the procedure	Low-osmolar contrast medium iohexol	1.6
CINSTEMI trial [22]	181	181	62	63	76.8	80.1	167 (mmol/L) SB intravenously as 500 mL in the first hour followed by infusion of 100 mL per hour in the next 5 hours	Nonionic iso-osmolar contrast medium	0.8
Ueda et al. [23]	30	29	77	75	77	79	0.5 mg/kg SB as soon as possible after hospital admission and 1 mL/kg/h during and 6 hours after the procedure	Low-osmolar contrast medium	1.4
Tamura et al. [24]	72	72	72.3	73.3	91.7	83.3	20 mEq SB 5 min before contrast exposure	Low-osmolar contrast medium iohexol	1.3
Shavit et al. [25]	51	36	72	71	84	70	154 mEq per liter SB in 5% dextrose in water mixed by adding 154 mL of the 1000 mEq per liter SB to 846 mL of 5% dextrose in water. The initial IV bolus was 3 mL/kg for 1 h before procedure and 1 mL/kg per liter for 6 hours after procedure	Low-osmolar contrast medium	1.8
RENO trial [26]	56	55	65	64	68	71	Initial IV bolus 5 mL/kg/h SB with 154 mEq per liter NaHCO3 in 5% glucose and H2O, after contrast same solution continued at 1.5 mL/kg/h for 12 h the day after contrast	Nonionic low-osmolality contrast medium	1.0
Ratcliffe et al. [17]	19	15	67	64	58	60	154 mEq per liter SB in 5% dextrose in water mixed by adding 154 mL of the 1000 mEq per liter SB to 846 mL of 5% dextrose in water. The initial IV bolus was 3 mL/kg for 1 h before procedure and 1 mL/kg per liter for 6 hours after procedure	Nonionic iso-osmolar contrast medium	106 micromol per liter
Pakfetrat et al. [27]	96	96	57.8	58.5	58.3	64.5	SB solution was prepared in the hospital pharmacy by adding 154 mL 1000 mEq per liter SB to 846 mL 5% dextrose in water and was infused at 3 mL/kg/h starting 1 h before contrast administration, followed by a 1 mL/kg/h infusion for 6 h after procedure	Nonionic iso-osmolar contrast medium	1.1
Ozcan et al. [28]	88	88	68	70	72.7	75	SB solution was prepared in the hospital pharmacy by adding 154 mL 1000 mEq per liter SB to 846 mL 5% dextrose in water and was infused at 1 mL/kg/h starting 6 h before contrast administration, followed by a 1 mL/kg/h infusion for 6 h after procedure	Ionic low-osmolality contrast medium	1.3
Motohiro et al. [29]	78	77	71	74	76	64	SB solution was prepared in the hospital pharmacy by adding 154 mL 1000 mEq per liter SB to 846 mL 5% dextrose in water and was infused at 1 mL/kg/h continued from 3 h before to 6 h after procedure	Nonionic low-osmolality contrast medium	1.5
Merten et al. [30]	60	59	66.7	69.2	73	76	SB solution was prepared in the hospital pharmacy by adding 154 mL 1000 mEq per liter SB to 846 mL 5% dextrose in water. The initial IV bolus was 3 mL/kg/h for 1 h immediately before radiocontrast injection. Following this, same fluid at a rate of 1 mL/kg/h during the contrast exposure and 6 h after the procedure	Nonionic low-osmolality contrast medium	1.7
Masuda et al. [31]	30	29	75	76	63	59	154 mL SB. Intravenous bolus was given at the rate of 3 mL/kg for 1 h before contrast injection, followed by an infusion of 1 mg/kg per hours during and 6 h after the procedure	Nonionic low-osmolality contrast medium	1.3
Maioli et al. [32]	250	252	74	74	57.2	60.7	154 mL SB. Intravenous bolus was given at the rate of 3 mL/kg for 1 h before contrast injection, followed by an infusion of 1 mg/kg per hours 6 h after the procedure	Nonionic iso-osmolar contrast medium	1.2
PREVENT trial [33]	193	189	68.5	67.5	70.5	71.4	154 mL SB. Intravenous bolus was given at the rate of 3 mL/kg for 1 h before contrast injection, followed by an infusion of 1 mg/kg per hours during and 6 h after the procedure	Nonionic iso-osmolar contrast medium	1.5
Koc et al. [34]	94	101	62	62	58	48	154 mL 1000 mEq per liter SB to 846 mL 5% dextrose in water and was infused at 1 mL/kg/h starting 6 h before contrast administration, followed by a 1 mL/kg/h infusion for 6 h after procedure	Nonionic iso-osmolar contrast medium	1.0
Klima et al. [35]	87	89	78	75	66	62	The initial IV bolus SB was 3 mL/kg/h of 166 mEq per liter for 1 h immediately before injection. Following this, same fluid at a rate of 1 mL/kg/h during the contrast exposure and for 6 h after the procedure.; SB 166 mEq as a bolus administrated over 20 min immediately before contrast. Additionally, oral SB (500 mg NaHCO3 per capsule: 1 capsule/10 kg) at the start of infusion and after contrast within 6 h	Nonionic iso-osmolar contrast medium	137 micomol per liter
Heguilén et al. [36]	43	38	67.7	69.3	62.7	78.9	154 mEq per liter of SB in 5% dextrose in H2O, mixed by adding 77 mL of 1000 mEq per liter SB to 423 mL of 5% dextrose in H2O and was infused at 3 mL/kg/h from at least 2 h pervious to procedure and 1 mL/kg/h during and for the next 6–12 h	Nonionic low-osmolality contrast medium	1.5
Hafiz et al. [37]	159	161	74	73	56.6	57.1	159 mEq per liter SB to 5% dextrose in water and was infused at 3 mL/kg/h starting 1 h before contrast administration, followed by a 1 mL/kg/h infusion for 6 h after procedure	Nonionic low-osmolality contrast medium	1.6
Gomes et al. [38]	150	151	64.1	64.5	69.3	74.8	154 mEq per liter SB to 5% dextrose in water and was infused at 3 mL/kg/h starting 1 h before contrast administration, followed by a 1 mL/kg/h infusion for 6 h after procedure	Ionic low-osmolality contrast medium	1.5
Castini et al. [39]	52	51	70	72.7	85	84	IV bolus administration of SB at a rate of 1 mL/kg body weight per hour for 12 hours before and 12 hours after contrast injection	Nonionic iso-osmolar contrast medium	1.5
Briguori et al. [40]	108	111	70	71	88	81	SB solution was prepared in the hospital pharmacy by adding 154 mL 1000 mEq per liter SB to 846 mL 5% dextrose in water. The initial IV bolus was 3 mL/kg/h for 1 h immediately before radiocontrast injection. Following this, same fluid at a rate of 1 mL/kg/h during the contrast exposure and 6 h after the procedure	Nonionic iso-osmolar contrast medium	2
Mahmoodi et al. [18]	175	175	64.9	64.4	43.4	59.4	Sodium bicarbonate solution was prepared by adding 154 mL of 1000 mEq/L sodium bicarbonate to 846 mL of 5% dextrose with water. All the patients received a fixed dose of fluid 6 h before the procedure and 6 h after it	Nonionic low-osmolality contrast medium	1.1
Author			Mean age (years)		Male (%)		Regimen on NAC	Contrast media	Mean baseline sCr
	SB	SB + NAC	SB	SB + NAC	SB	SB + NAC
Sodium bicarbonate versus sodium bicarbonate plus N-acetyl cysteine
Thayssen et al. (CINSTEMI trial) [22]	181	177	63	63	80.1	78.5	1200 mg NAC orally before procedure, followed by 1200 mg daily during the next 48 hours	Nonionic iso-osmolar contrast medium	0.8
Yang et al. [20]	159	150	59.6	60	52.8	54.67	600 mg NAC orally twice daily, at 24 h before and after procedure	Nonionic low-osmolality contrast medium	72 micromol per liter
Ratcliffe et al. [17]	19	23	64	65	60	70	1200 mg NAC intravenous bolus at 1 h before and 1200 mg orally twice daily for 48 h after procedure	Nonionic iso-osmolar contrast medium	103.3 micromol per liter
Heguilén et al. [36]	42	43	67.7	64.8	64.2	74.4	600 mg NAC orally twice daily, at 24 h before and after procedure	Nonionic low-osmolality contrast medium	1.5
Heng et al. [41]	32	28	N.D	N.D	N.D	N.D	1200 mg NAC twice daily at 24 h before and during procedure	N.D	N.D