This systematic review with meta-analysis sought to determine comparison of efficacy and safety of hydration with sodium bicarbonate versus sodium chloride on contrast induced nephropathy and clinical outcomes. We searched major electronic databases for studies in randomized controlled trials. A value of
The contrast-induced nephropathy (CIN) is the third most common cause of acute renal failure (ARF) worsening in preexisting renal function impairment that has been associated with morbidity, mortality, and prolonged hospitalization as well as increase in therapy costs [
This systematic review with meta-analysis sought to determine the strength of evidence for comparison of effects of sodium bicarbonate versus sodium chloride on incidence of CIN, requirement of hemodialysis, level of serum creatinine, and mortality after coronary angiography.
A comprehensive literature search was conducted in major electronic databases (Medline/Pubmed, Embase, Elsevier, Web of Knowledge, Sciences online database, and Google Scholar) from their inception through August 16, 2014, to identify RCTs that reported comparison of effects of sodium bicarbonate versus sodium chloride on incidence of CIN, requirement of hemodialysis, heart failure, mortality, duration of hospital stay, and levels of serum creatinine, sodium bicarbonate, and potassium. Predefined search terms included “sodium bicarbonate” and “sodium chloride” and “contrast-induced nephropathy,” “CIN,” “serum creatinine,” “coronary angiography,” and “coronary imaging.” No language restrictions were applied. All retrieved references of the included RCTs were also reviewed to determine additional studies not indexed in common databases. Studies were included into the analysis when they met the following criteria: (1) RCT, (2) comparison of hydration of sodium bicarbonate with a control group, and [
Two investigators (Sadegh Ali-Hassan-Sayegh, Elham Rahimizadeh) extracted the data independently, and discrepancies were resolved via a consensus standardized abstraction checklist used for recording data in each study. Data retrieved from the trials included author’s name, type of radiocontrast (low-, iso-, or high-osmolality), details of hydration regimens, mean baseline serum creatinine, study design, sample size, mean age, and gender. The incidence of CIN, requirement of hemodialysis, incidence of heart failure and mortality, duration of hospital stay, and levels of serum creatinine, sodium bicarbonate, and potassium were recorded for each group. For exploration of heterogeneity among trials, subgroup analysis of disparities in the patients’ characteristics was performed for (1) average age (<65 versus ≥65 years), (2) diabetes (≤30 versus >30%), (3) radiocontrast (low, iso), and (4) procedure (elective versus emergency).
CIN is defined as ≥25%, ≥0.5 mg/dL, ≥25%, and ≥0.5 mg/dL increase in creatinine from baseline and renal failure is defined as new onset of hemodialysis.
Data were analyzed by STATA version 11.0 utilizing METAN and METABIAS modules. The effect sizes measured were odds ratio (OR) with 95% confidence interval (CI) for categorical variable. For noncategorical data the weighted mean difference (WMD) with 95% CI was used for calculating differences in serum creatinine, sodium bicarbonate, and potassium and length of hospital stay between sodium bicarbonate and sodium chloride groups. OR < 1 favored sodium bicarbonate and OR > 1 favored sodium chloride. RCTs with no events in the 2 arms were discarded from pooled analysis. Forest plots were created for each outcome. A value of
Literature search retrieved 650 studies from screened databases of which 400 (61.5%) were excluded after initial review (Figure
Forest plot of odds ratio (OR) for hydration with sodium bicarbonate on contrast-induced nephropathy.
A total of 5698 patients were included from 28 RCTs reported data about effects of hydration with sodium bicarbonate on incidence of CIN (Table
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 | |||||||||
|
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Boucek et al. [ |
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 |
|
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Brar et al. [ |
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 |
|
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Alessandri et al. [ |
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 |
|
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REINFORCE trial [ |
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 |
|
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Yang et al. [ |
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 |
|
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Vasheghani-Farahani et al. [ |
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 |
|
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Vasheghani-Farahani et al. [ |
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 [ |
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 |
|
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Ueda et al. [ |
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 |
|
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Tamura et al. [ |
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. [ |
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 [ |
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. [ |
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 |
|
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Pakfetrat et al. [ |
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. [ |
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 |
|
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Motohiro et al. [ |
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 |
|
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Merten et al. [ |
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 |
|
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Masuda et al. [ |
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 |
|
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Maioli et al. [ |
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 |
|
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PREVENT trial [ |
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 |
|
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Koc et al. [ |
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 |
|
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Klima et al. [ |
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. |
Nonionic iso-osmolar contrast medium | 137 micomol per liter |
|
|||||||||
Heguilén et al. [ |
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. [ |
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. [ |
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. [ |
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. [ |
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. [ |
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 |
|
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Author |
|
Mean age (years) | Male (%) | Regimen on NAC | Contrast media | Mean baseline sCr | |||
SB | SB + NAC | SB | SB | SB + NAC | |||||
|
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Sodium bicarbonate versus sodium bicarbonate plus N-acetyl cysteine | |||||||||
|
|||||||||
Thayssen et al. (CINSTEMI trial) [ |
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. [ |
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. [ |
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. [ |
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. [ |
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 |
Clinical outcomes of included studies.
Author | CIN | Hemodialysis | Changes of serum levels of creatinine | Changes of serum levels of sodium bicarbonate | ||||
---|---|---|---|---|---|---|---|---|
SB | SC | SB | SC | SB | SC | SB | SC | |
Sodium bicarbonate versus saline | ||||||||
Boucek et al. [ |
7 | 5 | 0 | 0 | 14 ± 31 | 9 ± 26 | N.D | N.D |
Brar et al. [ |
26 | 30 | 1 | 2 | 11 ± 30.6 | 9.3 ± 26.9 | N.D | N.D |
Alessandri et al. [ |
10 | 15 | N.D | N.D | N.D | N.D | N.D | N.D |
REINFORCE trial [ |
3 | 2 | 3 | 2 | 1.7 ± 12.6 | 2.3 ± 11.8 | N.D | N.D |
Yang et al. [ |
8 | 5 | N.D | N.D | N.D | N.D | N.D | N.D |
Vasheghani-Farahani et al. [ |
1 | 2 | N.D | N.D | N.D | N.D | N.D | N.D |
Vasheghani-Farahani et al. [ |
4 | 4 | N.D | N.D | −3.35 ± 21 | −0.3 ± 18 | N.D | N.D |
CINSTEMI trial [ |
33 | 43 | 0 | 0 | N.D | N.D | N.D | N.D |
Ueda et al. [ |
2 | 8 | 0 | 0 | N.D | N.D | N.D | N.D |
Tamura et al. [ |
9 | 1 | 0 | 1 | N.D | N.D | N.D | N.D |
Shavit et al. [ |
5 | 3 | 0 | 0 | N.D | N.D | N.D | N.D |
RENO trial [ |
1 | 12 | 1 | 3 | N.D | N.D | N.D | N.D |
Ratcliffe et al. [ |
2 | 1 | N.D | N.D | 14.14 ± 12.38 | 10.6 ± 29.1 | N.D | N.D |
Pakfetrat et al. [ |
4 | 12 | 0 | 0 | N.D | N.D | N.D | N.D |
Ozcan et al. [ |
4 | 12 | 1 | 1 | N.D | N.D | N.D | N.D |
Motohiro et al. [ |
2 | 10 | 0 | 0 | N.D | N.D | 1.87 ± 1.43 | 0.12 ± 1.24 |
Merten et al. [ |
1 | 8 | 0 | 0 | N.D | N.D | 2.1 ± 2.6 | −0.7 ± 2.8 |
Masuda et al. [ |
2 | 10 | 1 | 3 | N.D | N.D | 3.2 ± 3.3 | 0.5 ± 3.1 |
Maioli et al. [ |
25 | 29 | 1 | 1 | N.D | N.D | N.D | N.D |
PREVENT trial [ |
10 | 17 | 4 | 1 | N.D | N.D | −0.49 ± 4.62 | −2.58 ± 8.75 |
Koc et al. [ |
17 | 7 | N.D | N.D | N.D | N.D | N.D | N.D |
Klima et al. [ |
15 | 2 | 2 | 0 | N.D | N.D | 2.2 ± 2.7 | −1.6 ± 2.3 |
Heguilén et al. [ |
3 | 6 | N.D | N.D | N.D | N.D | N.D | N.D |
Hafiz et al. [ |
14 | 19 | N.D | N.D | N.D | N.D | N.D | N.D |
Gomes et al. [ |
9 | 9 | 0 | 0 | N.D | N.D | N.D | N.D |
Castini et al. [ |
13 | 11 | 0 | 0 | N.D | N.D | N.D | N.D |
Briguori et al. [ |
2 | 11 | 1 | 1 | N.D | N.D | N.D | N.D |
Mahmoodi et al. [ |
12 | 34 | N.D | N.D | −0.17 ± 0.02 | 0.08 ± 0.02 | N.D | N.D |
|
||||||||
Author | CIN | Hemodialysis | Changes of serum levels of creatinine | Changes of serum levels of sodium bicarbonate | ||||
SB | SB + NAC | SB | SB + NAC | SB | SB + NAC | SB | SB + NAC | |
|
||||||||
Sodium bicarbonate versus sodium bicarbonate plus N-acetyl cysteine | ||||||||
Thayssen et al. (CINSTEMI trial) [ |
33 | 33 | 0 | 0 | — | — | — | — |
Yang et al. [ |
8 | 8 | N.D | N.D | — | — | — | — |
Ratcliffe et al. [ |
2 | 1 | N.D | N.D | — | — | — | — |
Heguilén et al. [ |
15 | 3 | N.D | N.D | — | — | — | — |
Heng et al. [ |
3 | 2 | N.D | N.D | — | — | — | — |
Author | Changes of serum levels of potassium | Length of hospital stay | Mortality | MACE | Jadad | ||||
---|---|---|---|---|---|---|---|---|---|
SB | SC | SB | SC | SB | SC | SB | SC | ||
Sodium bicarbonate versus saline | |||||||||
Boucek et al. [ |
N.D | N.D | 8.4 ± 12.9 | 8 ± 10 | 0 | 0 | 3 | 3 | 4 |
Brar et al. [ |
N.D | N.D | N.D | N.D | 3 | 3 | 4 | 8 | 4 |
Alessandri et al. [ |
N.D | N.D | N.D | N.D | N.D | N.D | N.D | N.D | 3 |
REINFORCE trial [ |
N.D | N.D | N.D | N.D | N.D | N.D | N.D | N.D | 5 |
Yang et al. [ |
N.D | N.D | N.D | N.D | N.D | N.D | N.D | N.D | 3 |
Vasheghani-Farahani et al. [ |
N.D | N.D | 1.5 ± 5 | 4.5 ± 3 | N.D | N.D | N.D | N.D | 5 |
Vasheghani-Farahani et al. [ |
N.D | N.D | 1 ± 3 | 1 ± 6 | N.D | N.D | N.D | N.D | 5 |
CINSTEMI trial [ |
N.D | N.D | N.D | N.D | N.D | N.D | N.D | N.D | 3 |
Ueda et al. [ |
N.D | N.D | 22.8 ± 17.9 | 21.4 ± 19.6 | 2 | 8 | 9 | 10 | 4 |
Tamura et al. [ |
N.D | N.D | N.D | N.D | 0 | 0 | 0 | 0 | 3 |
Shavit et al. [ |
N.D | N.D | N.D | N.D | N.D | N.D | N.D | N.D | 2 |
RENO trial [ |
N.D | N.D | N.D | N.D | 1 | 4 | N.D | N.D | 2 |
Ratcliffe et al. [ |
N.D | N.D | N.D | N.D | N.D | N.D | 0 | 0 | 3 |
Pakfetrat et al. [ |
N.D | N.D | N.D | N.D | 0 | 0 | N.D | N.D | 5 |
Ozcan et al. [ |
N.D | N.D | N.D | N.D | N.D | N.D | 0 | 0 | 2 |
Motohiro et al. [ |
−0.46 ± 0.61 | −0.32 ± 0.38 | N.D | N.D | 0 | 0 | 0 | 0 | 3 |
Merten et al. [ |
−0.26 ± 0.48 | −0.17 ± 0.59 | N.D | N.D | N.D | N.D | N.D | N.D | 3 |
Masuda et al. [ |
N.D | N.D | N.D | N.D | 0 | 2 | N.D | N.D | 3 |
Maioli et al. [ |
N.D | N.D | N.D | N.D | 4 | 3 | N.D | N.D | 5 |
PREVENT trial [ |
−0.3 ± 0.58 | −0.23 ± 0.52 | N.D | N.D | 0 | 1 | 10 | 3 | 5 |
Koc et al. [ |
N.D | N.D | N.D | N.D | N.D | N.D | N.D | N.D | 2 |
Klima et al. [ |
N.D | N.D | N.D | N.D | 5 | 4 | N.D | N.D | 4 |
Heguilén et al. [ |
N.D | N.D | N.D | N.D | N.D | N.D | N.D | N.D | 3 |
Hafiz et al. [ |
N.D | N.D | N.D | N.D | 0 | 0 | 0 | 0 | 3 |
Gomes et al. [ |
N.D | N.D | 7.5 ± 10 | 8.6 ± 9.7 | 7 | 5 | N.D | N.D | 2 |
Castini et al. [ |
N.D | N.D | N.D | N.D | N.D | N.D | N.D | N.D | 2 |
Briguori et al. [ |
N.D | N.D | N.D | N.D | N.D | N.D | N.D | N.D | 3 |
Mahmoodi et al. [ |
N.D | N.D | N.D | N.D | 0 | 0 | N.D | N.D | 2 |
|
|||||||||
Author | changes of serum levels of potassium | Length of hospital stay | Mortality | MACE | Jadad | ||||
SB | SB + NAC | SB | SB + NAC | SB | SB + NAC | SB | SB + NAC | ||
|
|||||||||
Sodium bicarbonate versus sodium bicarbonate plus N-acetyl cysteine | |||||||||
Thayssen et al. (CINSTEMI trial) [ |
— | — | — | — | — | — | 6 | 3 | 3 |
Yang et al. [ |
— | — | — | — | — | — | N.D | N.D | 3 |
Ratcliffe et al. [ |
— | — | — | — | — | — | 0 | 0 | 3 |
Heguilén et al. [ |
— | — | — | — | — | — | N.D | N.D | 3 |
Heng et al. [ |
— | — | — | — | — | — | N.D | N.D | 3 |
Subgroup analysis for clinical outcomes.
Subgroup | Studies ( |
Odd ratio or SMD (95% CI) |
|
---|---|---|---|
S.G.A for CIN according to OR | |||
Age | |||
≤65 | 11 | 0.770 (0.582–1.019) | 0.068 |
>65 | 16 | 0.765 (0.602–0.973) | 0.029 |
Diabetic mellitus | |||
≤30 | 9 | 0.708 (0.535–0.937) | 0.016 |
>30 | 14 | 0.774 (0.581–1.031) | 0.080 |
Radiocontrast | |||
Iso-osmolality | 9 | 0.902 (0.692–1.174) | 0.442 |
Low-osmolality |
18 | 0.663 (0.514–0.853) | 0.001 |
Procedure | |||
Elective | 23 | 0.869 (0.710–1.065) | 0.176 |
Emergency | 4 | 0.447 (0.290–0.687) | 0.000 |
|
|||
S.G.A for hemodialysis according to OR | |||
Age | |||
≤65 | 2 | 0.486 (0.088–2.697) | 0.409 |
>65 | 8 | 1.177 (0.540–2.564) | 0.681 |
Diabetic mellitus | |||
≤30 | 2 | 0.489 (0.088–2.702) | 0.412 |
>30 | 7 | 0.918 (0.387–2.180) | 0.847 |
Radiocontrast | |||
Iso-osmolality | 4 | 2.459 (0.704–8.583) | 0.158 |
Low-osmolality | 6 | 0.594 (0.238–1.484) | 0.265 |
Procedure | |||
Elective | 8 | 1.425 (0.629–2.226) | 0.396 |
Emergency | 2 | 0.307 (0.060–1.572) | 0.156 |
|
|||
S.G.A for mortality according to OR | |||
Age | |||
≤65 | 2 | 0.885 (0.336–2.331) | 0.804 |
>65 | 6 | 0.667 (0.341–1.303) | 0.236 |
Diabetic mellitus | |||
≤30 | 4 | 0.681 (0.339–1.368) | 0.280 |
>30 | 3 | 0.902 (0.352–2.311) | 0.830 |
Radiocontrast | |||
Iso-osmolality | 3 | 1.136 (0.444–2.906) | 0.791 |
Low-osmolality | 5 | 0.578 (0.290–1.151) | 0.119 |
Procedure | |||
Elective | 5 | 1.202 (0.618–2.339) | 0.588 |
Emergency | 3 | 0.199 (0.059–0.672) | 0.009 |
|
|||
S.G.A for length of hospital stay according to SMD | |||
Age | |||
≤65 | 4 | −0.104 (−0.247 to 0.039) | 0.153 |
>65 | 1 | 0.075 (−0.436 to 0.585) | 0.774 |
Diabetic mellitus | |||
≤30 | 2 | −0.240 (−0.526 to 0.047) | 0.101 |
>30 | 3 | −0.047 (−0.204 to 0.110) | 0.560 |
Radiocontrast | |||
Iso-osmolality | All studies were low osmolality | All studies were low osmolality | All studies were low osmolality |
Low-osmolality | |||
Procedure | |||
Elective | 4 | −0.104 (−0.247 to 0.039) | 0.153 |
Emergency | 1 | 0.075 (−0.436 to 0.585) | 0.774 |
|
|||
S.G.A for adverse events according to OR | |||
Age | |||
≤65 | 1 | 0966 (0.187–4.987) | 0.961 |
>65 | 3 | 1.093 (0.574–2.081) | 0.787 |
Diabetic mellitus | |||
≤30 | 1 | 0.817 (0.273–2.431) | 0.713 |
>30 | 2 | 0.625 (0.238–1.643) | 0.340 |
Radiocontrast | |||
Iso-osmolality | 1 | 3.388 (0.918–12.509) | 0.067 |
Low-osmolality | 3 | 0.701 (0.340–1.443) | 0.334 |
Procedure | |||
Elective | 3 | 1.213 (0.590–2.490) | 0.601 |
Emergency | 1 | 0.841 (0.273–2.431) | 0.713 |
|
|||
S.G.A mean changes of serum creatinine to SMD | |||
Age | |||
≤65 | 2 | −0.053 (−0.253 to 0.147) | 0.605 |
>65 | 3 | 0.036 (−0.134 to 0.206) | 0.677 |
Diabetic mellitus | |||
≤30 | 1 | −0.156 (−0.397 to 0.085) | 0.206 |
>30 | 4 | 0.062 (−0.092 to 0.215) | 0.432 |
Radiocontrast | |||
Iso-osmolality | 1 | −0.156 (−0.397 to 0.085) | 0.206 |
Low-osmolality | 4 | 0.062 (−0.092 to 0.215) | 0.432 |
Procedure | |||
Elective | All studies had elective procedure | All studies had elective procedure | All studies had elective procedure |
Emergency | |||
|
|||
S.G.A for mean changes of sodium bicarbonate according to SMD | |||
Age | |||
≤65 | All studies had age more than 65 years | All studies had age more than 65 years | All studies had age more than 65 years |
>65 | |||
Diabetic mellitus | |||
≤30 | — | — | — |
>30 | 4 | 1.248 (1.058 to 1.439) | 0.000 |
Radiocontrast | |||
Iso-osmolality | 2 | 0.622 (0.449 to 0.795) | 0.000 |
Low-osmolality | 3 | 1.120 (0.889 to 1.352) | 0.000 |
Procedure | |||
Elective | 4 | 0.797 (0.654 to 0.941) | 0.000 |
Emergency | 1 | 0.843 (0.310 to 1.376) | 0.002 |
A total of 3765 patients were included from 19 RCTs reporting data on requirement of hemodialysis (Table
Forest plot of odds ratio (OR) for hydration with sodium bicarbonate on incidence of requirement dialysis.
From 1267 patients, 636 cases were allocated to SB and 631 to the SC group (Table
Forest plot of weighted mean differences (WMD) for hydration with sodium bicarbonate on mean changes of creatinine.
Mean LHS for 5 trials (817 patients) were
After discarding 5 RCTs for having no events in 2 comparative arms, 4 RCTs (914 patients) were included in the analysis. Major adverse cardiovascular events occurred in 5.66% of the cases in SB group and 5.27% in SC group (Tables
After discarding 7 RCTs because of no death event in 2 comparative arms, 8 RCTs were used for the meta-analysis. Mortality occurred in 2.26% in SB and 3.08% in SC group (Tables
A total of 5 RCTs (854 patients) were used for the analysis. Patient population of the RCTs ranged from 42 to 358 patients. From 854 patients, 433 cases were allocated to SB alone and 421 to the SB plus NAC group. The overall incidence of CIN was 12.67% ranging from 5.17% to 21.17%. CIN occurred in 14.08% in SB alone and 11.16% in SB plus NAC group. Pooled treatment effect analysis revealed that SB plus NAC versus SB alone had trend towards reducing the incidence of CIN with an OR of 1.32 (95% CI: 0.87–1.99;
Forest plot of odds ratio (OR) for treatment with N-acetyl cysteine and hydration with sodium bicarbonate on contrast-induced nephropathy.
CIN occurs in more than 15% of patients with chronic renal impairment undergoing diagnostic and therapeutic radiographic procedure [
A number of studies have found that changes in creatinine levels within 24 to 48 hours after exposure to radiocontrast could be considered as equivalent indicator for new onset CIN [
The authors declare that there is no conflict of interests regarding the publication of this paper.
Sadegh Ali-Hassan-Sayegh and Seyed Jalil Mirhosseini contributed equally to this review.
The authors would like to thank Dr. Ali Akbar Karimi, Dr. Arezoo Shahidzadeh, and Dr. Fatemeh Haddad for their assistance in writing the paper and Dr. Parisa Mahdavi, Dr. Mahbube Tahernejad, and Dr. Azadeh Shahidzadeh for their assistance in collecting data and statistical analysis.