Sodium bicarbonate versus isotonic saline solution to prevent contrast-induced nephropathy : a systematic review and meta-analysis
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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.
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.
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.
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.
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.
Merten GJ, Burgess WP, Gray L V, et al. Prevention of Contrast-Induced Nephropathy With Sodium Bicarbonate. JAMA. 2004;291(19):2328-2334.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Sanaei-Ardekani M, Movahed M-R, Movafagh S GN. Contrast-induced nephropathy: a review. Cardiovasc Revasc Med. 2005;6(2):82-88.
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.
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.
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.
Bartholmai B, Williams Aw, Cha S, McDonald F. Mortality associated with nephropathy after radiographic contrast exposure. Mayo Clin Proc. 2008;83:1095-1100.
Nash KB, Hou S. Hospital-acquired renal insufficiency. Am J Kidney Dis. 2002;39:930-936.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
McCullough P. Contrast-induced acute kidney injury. J Am Coll Cardiol. 2008;51:419-428.
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- 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)
Accepted 2015-08-20
Published 2015-09-30
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