Amit X. Garg, MD, PhD
Are sodium bicarbonate regimens effective and safe for prevention of contrast-induced nephropathy (CIN)?
Included studies assessed strategies involving intravenous sodium bicarbonate to prevent CIN in patients ≥ 18 years of age. Outcomes included CIN (25% increase in baseline serum creatinine level or absolute increase of 44 µmol/L [0.5 mg/dL] 2 to 5 d after administration of radiocontrast), mortality, heart failure, and need for dialysis.
MEDLINE, EMBASE/Excerpta Medica, and Cochrane Central Register of Controlled trials (all to Dec 2008); ClinicalTrials.gov; conference proceedings; and reference lists were searched for completed randomized controlled trials (RCTs). 23 RCTs (n = 3563, mean age > 48 y, 59% to 84% men, mean baseline serum creatinine 71 to 177 µmol/L [0.8 to 2.0 mg/dL]) met the selection criteria. 9 were published (n = 1846), and 14 were unpublished (n = 1717); 5 of the 9 published trials had Jadad scores ≥ 3. Most studies assessed patients having cardiac catheterization. 10 RCTs compared sodium bicarbonate with sodium chloride (saline), 8 compared sodium bicarbonate plus N-acetylcysteine with sodium chloride plus N-acetylcysteine, and 1 compared sodium bicarbonate plus oral acetazolamide with sodium chloride; other comparisons involved various combinations of sodium bicarbonate and sodium chloride with and without N-acetylcysteine.
Meta-analysis of published trials showed that sodium bicarbonate reduced risk for CIN compared with saline, whereas meta-analysis of unpublished studies showed no difference between groups (Table). Publication bias was present (Egger test P = 0.009). Groups did not differ for mortality, heart failure, or need for dialysis (Table).
Evidence on the effectiveness of sodium bicarbonate regimens to prevent contrast-induced nephropathy is unclear.
Sodium bicarbonate vs saline to prevent contrast-induced nephropathy (CIN)*
*NS = not significant; other abbreviations defined in Glossary. Weighted event rates, RRR, NNT, and CI calculated from data in article using a random-effects model.
Garg AX. Review: Evidence on the effectiveness of sodium bicarbonate regimens to prevent contrast-induced nephropathy is unclear. Ann Intern Med. ;152:JC5–10. doi: 10.7326/0003-4819-152-10-201005180-02010
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Published: Ann Intern Med. 2010;152(10):JC5-10.
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