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Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination (UK); 1995-.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews.

Sodium bicarbonate for prevention of contrast-induced acute kidney injury: a systematic review and meta-analysis

Review published: 2010.

Bibliographic details: Hoste EA, De Waele JJ, Gevaert SA, Uchino S, Kellum JA.  Sodium bicarbonate for prevention of contrast-induced acute kidney injury: a systematic review and meta-analysis. Nephrology Dialysis Transplantation 2010; 25(3): 747-758. [PubMed: 19703838]

Quality assessment

This review concluded that use of sodium bicarbonate in patients who underwent intravascular iodinated contrast-enhanced radiography procedures reduced the risk of contrast-induced acute kidney injury. This was a borderline effect and there was no benefit for other outcomes. The included studies had variable findings and were low quality. The authors' conclusions are appropriately cautious and likely to be reliable. Full critical summary

Abstract

BACKGROUND: There have been conflicting reports on the use of intravenous administration of sodium bicarbonate for prevention of contrast-induced acute kidney injury (CI-AKI). The aim of this study was to evaluate the use of sodium bicarbonate for prevention of CI-AKI.

METHODS: This is a symptomatic review and meta-analysis of prospectively randomized studies, abstracts and manuscripts, published from 1950 to 20 February 2009.

RESULTS: Of 192 identified publications, 18 studies (n = 3055) were included. Nine studies were only published as an abstract. CI-AKI occurred in 11.6%. Six prospective studies demonstrated that intervention with sodium bicarbonate resulted in a decreased risk of CI-AKI. The aggregate result of the prospective trials also demonstrated a benefit favouring sodium bicarbonate (RR = 0.66, 95% CI = 0.45-0.95). This effect was most prominent in coronary procedures and in patients with chronic kidney disease. There was no effect on need for renal replacement therapy (RRT) and mortality. Published manuscripts demonstrated a beneficial effect, while abstracts could not. Also, funnel plot analysis suggested a publication bias. In addition, we found significant clinical and statistical heterogeneity between studies. Finally, the quality of the individual studies was limited.

CONCLUSIONS: The incidence of CI-AKI was higher than recently reported, and varied among study cohorts. We found a preventive effect of the use of sodium bicarbonate on the risk for CI-AKI, however, with borderline statistical significance. There was no effect on need for RRT or mortality. The relative low quality of the individual studies, heterogeneity and possible publication bias means that only a limited recommendation can be made in favour of the use of sodium bicarbonate.

CRD has determined that this article meets the DARE scientific quality criteria for a systematic review.

Copyright © 2013 University of York.

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