Sodium bicarbonate versus isotonic saline solution to prevent contrast-induced nephropathy : a systematic review and meta-analysis
Article Sidebar
Main Article Content
Introduction: Contrast-induced nephropathy is one of the main causes of acute kidney injury and increased hospital-acquired morbidity and mortality. The use of sodium bicarbonate for nephroprotection has emerged as a preventative strategy; however, its efficacy is controversial compared to other strategies, such as hydration using 0.9% saline solution.
Objective: To compare the effectiveness of sodium bicarbonate vs. hydration using 0.9% saline solution to prevent contrast-induced acute kidney injury.
Methods: A systematic review of studies registered in the Cochrane, Pubmed, Medline, Lilacs, ScielO and Embase databases was conducted. Randomized controlled studies that evaluated the use of 0.9% saline solution vs. sodium bicarbonate to prevent contrast-induced nephropathy were included.
Results: A total of 22 studies (5,686 patients) were included. Sodium bicarbonate did not decrease the risk of contrast-induced nephropathy (RD= 0.00; 95% CI= -0.02 to 0.03; p= 0.83; I2= 0%). No significant differences were found in the demand for renal replacement therapy (RD= 0.00; 95% CI= -0.01 to 0-01; I2= 0%; p= 0.99) or in mortality (RD= -0.00; 95% CI= -0.001 to 0.001; I2= 0%; p= 0.51).
Conclusions: Sodium bicarbonate administration is not superior to the use of 0.9% saline solution for preventing contrast-induced nephropathy in patients with risk factors, nor is it better at reducing mortality or the need for renal replacement therapy.
Chao C. Epidemiology, clinical features and diagnosis of contrast induced nephropathy: a brief review. Gen Med. 2013;1:102.
Andreucci M, Faga T, Pisani A, Sabbatini M, Russo D, Michael A. Prevention of Contrast-Induced Nephropathy through a Knowledge of Its Pathogenesis and Risk Factors. ScientificWorldJournal. 2014;2014:1-16. doi:10.1155/2014/823169. DOI: https://doi.org/10.1155/2014/823169
Golshahi J, Nasri H, Gharipour M. Contrast-induced nephropathy; A literature review. J Nephropathol. 2014;3(2):51-56. doi:10.12860/jnp.2014.12.
Au TH, Bruckner A, Mohiuddin SM, Hilleman DE. The prevention of contrast-induced nephropathy. Ann Pharmacother. 2014;48(10):1332-1342. doi:10.1177/1060028014541996. DOI: https://doi.org/10.1177/1060028014541996
Gonçalves da Silva R, et al. Prevention of contrast-induced nephropathy by use of bicarbonate solution - preliminary results and literature review. J Bras Nefrol. 2010;32(3):288-297.
Mueller C, Buerkle G, Buettner HJ. Prevention of contrast media-associated nephropathy: randomized comparison of 2 hydration regimens in 1620 patients undergoing coronary angioplasty. Arch Intern Med. 2002;162(3):329-336. DOI: https://doi.org/10.1001/archinte.162.3.329
Trivedi H, Moor H, Nasr S, et al. A randomized prospective trial to assess the role of saline hydration on the development of contrast nephrotoxicity. Nephron Clin Pract. 2003;93(1):C29-C34. DOI: https://doi.org/10.1159/000066641
Marenzi G, Ferrari C, Marana I et al. Prevention of contrast nephropathy by furosemide with matched hydration: the MYTHOS (induced diuresis with matched hydration compared to standard hydration for contrast induced nephropathy prevention) trial. Cardiovasc Interv. 2012;5(1):90-97. DOI: https://doi.org/10.1016/j.jcin.2011.08.017
Merten GJ, Burgess WP, Gray L V, et al. Prevention of Contrast-Induced Nephropathy With Sodium Bicarbonate. JAMA. 2004;291(19):2328-2334. DOI: https://doi.org/10.1001/jama.291.19.2328
Caulfield JL, Singh SP, Wishnok JS, Deen WM TS. Bicarbonate inhibits N-nitrosation in oxygenated nitric oxide solutions. J Biol Chem. 1996;271(42):25859-25863. DOI: https://doi.org/10.1074/jbc.271.42.25859
Barlak A, Akar H, Yenicerioglu Y, Yenisey C, Meteoğlu I YO. Effect of sodium bicarbonate in an experimental model of radiocontrast nephropathy. Ren Fail. 2010;32(8):992-999. DOI: https://doi.org/10.3109/0886022X.2010.502282
KDIGO. Clinical Guidelines. National Kidney Foundation. Kidney Int Suppl. 2013.
Sobre I, Manual EL, Manual S. Manual Cochrane de revisiones sistemáticas de intervenciones. cochrane Collab. 2011;(March):1-639.
Urrútia G, Bonfill X. Declaración PRISMA: una propuesta para mejorar la publicación de revisiones sistemáticas y metaanálisis. Med Clin (Barc). 2010;135(11):507-511. doi:10.1016/j.medcli.2010.01.015. DOI: https://doi.org/10.1016/j.medcli.2010.01.015
Masuda M, Yamada T, Mine T, et al. Comparison of usefulness of sodium bicarbonate versus sodium chloride to prevent contrast-induced nephropathy in patients undergoing an emergent coronary procedure. Am J Cardiol. 2007;100(5):781-786. doi:10.1016/j.amjcard.2007.03.098. DOI: https://doi.org/10.1016/j.amjcard.2007.03.098
Briguori C, Airoldi F, D’Andrea D, et al. Renal Insufficiency Following Contrast Media Administration Trial (REMEDIAL): a randomized comparison of 3 preventive strategies. Circulation. 2007;115(10):1211-1217. doi:10.1161/CIRCULATIONAHA.106.687152. DOI: https://doi.org/10.1161/CIRCULATIONAHA.106.687152
Ozcan EE, Guneri S, Akdeniz B, et al. Sodium bicarbonate, N-acetylcysteine, and saline for prevention of radiocontrast-induced nephropathy. A comparison of 3 regimens for protecting contrast-induced nephropathy in patients undergoing coronary procedures. A single-center prospective controlled. Am Heart J. 2007;154(3):539-544. doi:10.1016/j.ahj.2007.05.012. DOI: https://doi.org/10.1016/j.ahj.2007.05.012
Adolph E, Holdt-Lehmann B, Chatterjee T, et al. Renal Insufficiency Following Radiocontrast Exposure Trial (REINFORCE): a randomized comparison of sodium bicarbonate versus sodium chloride hydration for the prevention of contrast-induced nephropathy. Coron Artery Dis. 2008;19(6):413-419. doi:10.1097/MCA.0b013e3283021ac6. DOI: https://doi.org/10.1097/MCA.0b013e3283021ac6
Maioli M, Toso A, Leoncini M, et al. Sodium bicarbonate versus saline for the prevention of contrast-induced nephropathy in patients with renal dysfunction undergoing coronary angiography or intervention. J Am Coll Cardiol. 2008;52(8):599-604. doi:10.1016/j.jacc.2008.05.026. DOI: https://doi.org/10.1016/j.jacc.2008.05.026
Brar SS, Yuh-Jer A, Jorgensen MB, et al. Sodium Bicarbonate vs Sodium Chloride for the Prevention of Contrast Undergoing Coronary Angiography. JAMA. 2008;300(9):1038-1146. DOI: https://doi.org/10.1001/jama.300.9.1038
Pakfetrat M, Nikoo MH, Malekmakan L, et al. A comparison of sodium bicarbonate infusion versus normal saline infusion and its combination with oral acetazolamide for prevention of contrast-induced nephropathy: a randomized, double-blind trial. Int Urol Nephrol. 2009;41(3):629-634. doi:10.1007/s11255-008-9520-y. DOI: https://doi.org/10.1007/s11255-008-9520-y
Cho R, Javed N, Traub D, Kodali S, Atem F, Srinivasan V. Oral hydration and alkalinization is noninferior to intravenous therapy for prevention of contrast-induced nephropathy in patients with chronic kidney disease. J Interv Cardiol. 2010;23(5):460-466. doi:10.1111/j.1540-8183.2010.00585.x. DOI: https://doi.org/10.1111/j.1540-8183.2010.00585.x
Castini D, Lucreziotti S, Bosotti L, et al. Prevention of contrast-induced nephropathy: a single center randomized study. Clin Cardiol. 2010;33(3):E63-E68. doi:10.1002/clc.20576. DOI: https://doi.org/10.1002/clc.20576
Lee SW, Kim WJ, Kim YH, et al. Preventive strategies of renal insufficiency in patients with diabetes undergoing intervention or arteriography (the prevent trial). Am J Cardiol. 2011;107(10):1447-1452. doi:10.1016/j.amjcard.2011.01.019. DOI: https://doi.org/10.1016/j.amjcard.2011.01.019
Maioli M, Toso A, Leoncini M, Micheletti C, Bellandi F. Effects of hydration in contrast-induced acute kidney injury after primary angioplasty: a randomized, controlled trial. Circ Cardiovasc Interv. 2011;4(5):456-462. doi:10.1161/CIRCINTERVENTIONS.111.961391. DOI: https://doi.org/10.1161/CIRCINTERVENTIONS.111.961391
Gomes VO, Lasevitch R, Lima VC, et al. Hydration with Sodium Bicarbonate Does Not Prevent Contrast Nephropathy : A Multicenter Clinical Trial. Arq Bras Cardiol. 2012;99(6):1129-1134. DOI: https://doi.org/10.1590/S0066-782X2012005000108
Klima T, Christ A, Marana I, et al. Sodium chloride vs. sodium bicarbonate for the prevention of contrast medium-induced nephropathy: a randomized controlled trial. Eur Heart J. 2012;33(16):2071-2079. doi:10.1093/eurheartj/ehr501. DOI: https://doi.org/10.1093/eurheartj/ehr501
Hafiz AM, Jan MF, Mori N, et al. Prevention of contrast-induced acute kidney injury in patients with stable chronic renal disease undergoing elective percutaneous coronary and peripheral interventions: randomized comparison of two preventive strategies. Catheter Cardiovasc Interv. 2012;79(6):929-937. doi:10.1002/ccd.23148. DOI: https://doi.org/10.1002/ccd.23148
Koc F, Ozdemir K, Altunkas F, et al. Sodium bicarbonate versus isotonic saline for the prevention of contrast-induced nephropathy in patients with diabetes mellitus undergoing coronary angiography and/or intervention: a multicenter prospective randomized study. J Investig Med. 2013;61(5):872-877. doi:10.231/JIM.0b013e31828e9cab. DOI: https://doi.org/10.2310/JIM.0b013e31828e9cab
Boucek P, Havrdova T, Oliyarnyk O, et al. Prevention of contrast-induced nephropathy in diabetic patients with impaired renal function: a randomized, double blind trial of sodium bicarbonate versus sodium chloride-based hydration. Diabetes Res Clin Pract. 2013;101(3):303-308. doi:10.1016/j.diabres.2013.05.015. DOI: https://doi.org/10.1016/j.diabres.2013.05.015
Kooiman J, Sijpkens YWJ, de Vries J-PPM, et al. A randomized comparison of 1-h sodium bicarbonate hydration versus standard peri-procedural saline hydration in patients with chronic kidney disease undergoing intravenous contrast-enhanced computerized tomography. Nephrol Dial Transplant. 2014;29(5):1029-1036. doi:10.1093/ndt/gfu025. DOI: https://doi.org/10.1093/ndt/gfu025
Mahmoodi K, Sohrabi B, Ilkhchooyi F, Malaki M, Khaniani ME, Hemmati M. The Efficacy of Hydration with Normal Saline Versus Hydration with Sodium Bicarbonate in the Prevention of Contrast-induced Nephropathy. Heart Views. 2014;15(2):33-36. doi:10.4103/1995-705X.137489. DOI: https://doi.org/10.4103/1995-705X.137489
Nieto-Ríos JF, Salazar WAM, Sánchez OMS, et al. Prevention of contrast induced nephropathy with sodium bicarbonate (the PROMEC study). J Bras Nefrol. 2014;36(3):360-366. doi:10.5935/0101-2800.20140051. DOI: https://doi.org/10.5935/0101-2800.20140051
Manari A, Magnavacchi P, Puggioni E, et al. Acute kidney injury after primary angioplasty: effect of different hydration treatments. J Cardiovasc Med (Hagerstown). 2014;15(1):60-67. doi:10.2459/JCM.0b013e3283641bb8. DOI: https://doi.org/10.2459/JCM.0b013e3283641bb8
Yang K, Liu W, Ren W, Lv S. Different interventions in preventing contrast-induced nephropathy after percutaneous coronary intervention. Int Urol Nephrol. 2014;(2):1801-1807. doi:10.1007/s11255-014-0765-3. DOI: https://doi.org/10.1007/s11255-014-0765-3
Sanaei-Ardekani M, Movahed M-R, Movafagh S GN. Contrast-induced nephropathy: a review. Cardiovasc Revasc Med. 2005;6(2):82-88. DOI: https://doi.org/10.1016/j.carrev.2005.07.004
Feldkamp T KA. Contrast media induced nephropathy: definition, incidence, outcome, pathophysiology, risk factors and prevention. Minerva Med. 2008;99(2):177-196.
Jorgensen A. Contrast-induced nephropathy: pathophysiology and preventive strategies. Crit Care Nurse. 2013;33(1):37-46. DOI: https://doi.org/10.4037/ccn2013680
McCullough P, Wolyn R, Rocher L, Levin R, O´Neill W. Acute renal failure after coronary intervention: Incidece, risk factor and relationship to mortality. Am J Med. 1997;103:368-375. DOI: https://doi.org/10.1016/S0002-9343(97)00150-2
Gupta R, Gurm H, Bhatt D, Chew D, Ellis S. Renal failure after percutaneous coronary intervention is associated with high mortality. Catheter Cardiovasc Interv. 2005;64:442-448. DOI: https://doi.org/10.1002/ccd.20316
Bartholmai B, Williams Aw, Cha S, McDonald F. Mortality associated with nephropathy after radiographic contrast exposure. Mayo Clin Proc. 2008;83:1095-1100. DOI: https://doi.org/10.4065/83.10.1095
Nash KB, Hou S. Hospital-acquired renal insufficiency. Am J Kidney Dis. 2002;39:930-936. DOI: https://doi.org/10.1053/ajkd.2002.32766
Roghi A, Savonitto S, Cavallini C, Arraiz G, Angoli L, Castriota F. Impact of acute renal failure following pecutaneous coronary intervention on long-term mortality. J Cardiovasc Med. 2008;9:375-381. DOI: https://doi.org/10.2459/JCM.0b013e3282eee979
Pattharanitima P, Tasanarong A. Pharmacological strategies to prevent contrast-induced acute kidney injury. Biomed Res Int. 2014;2014:1-21. doi:10.1155/2014/236930. DOI: https://doi.org/10.1155/2014/236930
Katholi RE, Woods WT Jr, Taylor GJ, Deitrick CL, Womack KA, Katholi CR et al. Oxygen free radicals and contrast ne- phropathy. Am J Kidney Dis. 1998;32:64-71. DOI: https://doi.org/10.1053/ajkd.1998.v32.pm9669426
Recio-Mayoral A, Chaparro M, Prado B, et al. The reno-protective effect of hydration with sodium bicarbonate plus N-acetylcysteine in patients undergoing emergency percutaneous coronary intervention: the RENO Study. J Am Coll Cardiol. 2007;49(12):1283-1288. doi:10.1016/j.jacc.2006.11.034. DOI: https://doi.org/10.1016/j.jacc.2006.11.034
Schmidt P, Pang D, Nykamp D, Knowlton G JH. N-ace- tylcysteine and sodium bicarbonate versus N-acetylcysteine and standard hydration for the prevention of radiocontrast- -induced nephropathy following coronary angiography. Ann Pharmacother. 2007;41:46-50. DOI: https://doi.org/10.1345/aph.1H354
Kunadian V, Zaman A, Spyridopoulos I QW. Sodium bicarbonate for the prevention of contrast induced nephro- pathy: a meta-analysis of published clinical trials. Eur J Ra- diol. 2011;79:48-55. DOI: https://doi.org/10.1016/j.ejrad.2009.12.015
Jang JS, Jin HY, Seo JS, Yang TH, Kim DK, Kim TH. Sodium Bicarbonate Therapy for the Prevention of Contrast-Induced Acute Kidney Injury. A Sistematic Review and Meta-Analysis. Circ J. 2012;76:2255-2265. DOI: https://doi.org/10.1253/circj.CJ-12-0096
Meier P, Ko DT, Tamura A, Tamhane U, Gurm HS. Sodium bicarbonate-based hydratation prevents contrast-induced nephropathy: a meta-analysis. BMC Med. 2009;7:23-34. DOI: https://doi.org/10.1186/1741-7015-7-23
Hogan SE, L´Allier P, Chetcuti S, Grossman PM, Nallamothu BK, Duvernoy C. Current role of sodium bicarbonate-based preprocedural hydration for the pevention of contrast-induced acute kidney injury: A meta-analysis. Am Hear J. 2008;156:414-421. DOI: https://doi.org/10.1016/j.ahj.2008.05.014
Solomon R, Natarajan MK, Doucet S, Sharma SK, Staniloae CS, Katholi RE. Cardiac angiography in renally impaired patients (CARE) study: A randomized double-blind trial of contrast-induced nephropathy in patients with chronic kidney disease. Circulation. 2007;115:3189-3196. DOI: https://doi.org/10.1161/CIRCULATIONAHA.106.671644
Wessely R, Koppara T, Bradaric C, Vorpahl M, Braun S, Schulz S. Choice of contrast medium in patients with impaired renal function undergoing percutaneous coronary intervention. Circ Cardiovasc Interv. 2009;2:430-437. DOI: https://doi.org/10.1161/CIRCINTERVENTIONS.109.874933
Bolognese L, Falsini G, Schwenke C, Grotti S, Limbruno U, Liistro F. Impact of iso-osmolar versus low-osmolar contrast agents on contrast-induced nephropathy and tissue reperfusion in unselected patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention (from the contrast. Am J Cardiol. 2012;109:67-74. DOI: https://doi.org/10.1016/j.amjcard.2011.08.006
McCullough P. Contrast-induced acute kidney injury. J Am Coll Cardiol. 2008;51:419-428. DOI: https://doi.org/10.1053/j.ajkd.2007.12.004
Downloads
- John Fredy Nieto-Ríos, Lina María Serna-Higuita, Sheila Alexandra Builes-Rodriguez, Ricardo Cesar Restrepo-Correa, Arbey Aristizabal-Alzate, Catalina Ocampo-Kohn, Angelica Serna-Campuzano, Natalia Cardona-Díaz, Nelson Dario Giraldo-Ramirez, Gustavo Adolfo Zuluaga-Valencia, Clinical outcomes of kidney transplants on patients with end-stage renal disease secondary to lupus nephritis, polycystic kidney disease and diabetic nephropathy , Colombia Medica: Vol. 47 No. 1 (2016)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
The copy rights of the articles published in Colombia Médica belong to the Universidad del Valle. The contents of the articles that appear in the Journal are exclusively the responsibility of the authors and do not necessarily reflect the opinions of the Editorial Committee of the Journal. It is allowed to reproduce the material published in Colombia Médica without prior authorization for non-commercial use