Systematic Review: Sodium Bicarbonate Treatment Regimens for the Prevention of Contrast-Induced Nephropathy

doi:10.1059/0003-4819-151-9-200911030-00008

Systematic Review: Sodium Bicarbonate Treatment Regimens for the Prevention of Contrast-Induced Nephropathy

Sophia Zoungas, MD, PhD;
Toshiharu Ninomiya, MD, PhD;
Rachel Huxley, DPhil;
Alan Cass, MD, PhD;
Meg Jardine, MD, PhD;
Martin Gallagher, MD;
Anushka Patel, MD, PhD;
Ali Vasheghani-Farahani, MD;
Gelareh Sadigh, MD; and
Vlado Perkovic, MD, PhD

From the University of Sydney, Sydney, and Monash University, Melbourne, Australia, and Tehran University of Medical Sciences, Tehran, Iran.

Abstract

Background: Intravenous sodium bicarbonate has been proposed to reduce the risk for contrast-induced nephropathy (CIN).

Purpose: To determine the effect of sodium bicarbonate on the risk for CIN.

Data Sources: MEDLINE, PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials from 1950 to December 2008; conference proceedings; and ClinicalTrials.gov, without language restriction.

Study Selection: Randomized, controlled trials of intravenous sodium bicarbonate that prespecified the outcome of CIN as a 25% increase in baseline serum creatinine level or an absolute increase of 44 μmol/L (0.5 mg/dL) after radiocontrast administration.

Data Extraction: Using standardized protocols, 2 reviewers serially abstracted data for each study.

Data Synthesis: 23 published and unpublished trials with information on 3563 patients and 396 CIN events were included. The pooled relative risk was 0.62 (95% CI, 0.45 to 0.86), with evidence of significant heterogeneity across studies (I ² = 49.1%; P = 0.004). Some heterogeneity was due to the difference in the estimates between published and unpublished studies: relative risk, 0.43 (CI, 0.25 to 0.75) versus 0.78 (CI, 0.52 to 1.17), respectively. Meta-regression showed that small, poor-quality studies that assessed outcomes soon after radiocontrast administration were more likely to suggest benefit (P < 0.05 for all). No clear effects of treatment on the risk for dialysis, heart failure, and total mortality were identified.

Limitation: Power to assess clinical end points was limited.

Conclusion: The effectiveness of sodium bicarbonate treatment to prevent CIN in high-risk patients remains uncertain. Earlier reports probably overestimated the magnitude of any benefit, whereas larger, more recent trials have had neutral results. Large multicenter trials are required to clarify whether sodium bicarbonate has value for prevention of CIN before routine use can be recommended.

Primary Funding Source: None.

Article and Author Information

Grant Support: Dr. Zoungas was supported by a National Health and Medical Research Council of Australia Health Professional Research Fellowship. Dr. Perkovic was supported by a National Heart Foundation of Australia AstraZeneca research fellowship. Dr. Cass was supported by a National Health and Medical Research Council of Australia Senior Research Fellowship. Drs. Huxley and Patel are supported by National Heart Foundation of Australia Career Development awards.
Potential Conflicts of Interest: None disclosed.
Requests for Single Reprints: Sophia Zoungas, MD, PhD, The George Institute for International Health, University of Sydney, PO Box M201, Missenden Road, Sydney, New South Wales 2050, Australia; e-mail, szoungas{at}george.org.au.
Current Author Addresses: Drs. Zoungas, Ninomiya, Huxley, Cass, Jardine, Gallagher, Patel, and Perkovic: The George Institute for International Health, University of Sydney, PO Box M201, Missenden Road, Sydney, New South Wales 2050, Australia.
Drs. Vasheghani-Farahani and Sadigh: Department of Cardiology, Tehran Heart Centre, Tehran University of Medical Sciences, Tehran 1411713138, Iran.
Author Contributions: Conception and design: S. Zoungas, T. Ninomiya, A. Cass, V. Perkovic.
Analysis and interpretation of the data: S. Zoungas, T. Ninomiya, R. Huxley, A. Cass, M. Jardine, M. Gallagher, V. Perkovic.
Drafting of the article: S. Zoungas, T. Ninomiya, R. Huxley, M. Gallagher, V. Perkovic.
Critical revision of the article for important intellectual content: T. Ninomiya, R. Huxley, A. Cass, M. Jardine, M. Gallagher, A. Patel, V. Perkovic.
Final approval of the article: S. Zoungas, T. Ninomiya, R. Huxley, A. Cass, M. Jardine, M. Gallagher, A. Patel, A. Vasheghani-Farahani, G. Sadigh, V. Perkovic.
Provision of study materials or patients: A. Vasheghani-Farahani, G. Sadigh.
Statistical expertise: S. Zoungas.
Obtaining of funding: A. Cass.
Administrative, technical, or logistic support: V. Perkovic, T. Ninomiya.
Collection and assembly of data: S. Zoungas, T. Ninomiya.