Systematic review

Sodium bicarbonate treatment regimens for the prevention of contrast-induced nephropathy

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

Research output: Contribution to journalReview articleResearchpeer-review

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Data Synthesis: 23 published and unpublished trials with information on 3563 patients and 396 CIN events were included.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 (I2 = 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 Some heterogeneity was due to the difference in the estimates between published and unpublished studies: relative risk, 0.43 (CI, 0.25 to 0.75) versus 0.78 (CI, 0.52 to 1.17), respectively. Metaregression 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.

Original languageEnglish
Pages (from-to)631-638
Number of pages8
JournalAnnals of Internal Medicine
Volume151
Issue number9
DOIs
Publication statusPublished - 3 Nov 2009
Externally publishedYes

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Sodium Bicarbonate
Therapeutics
Information Storage and Retrieval
PubMed
MEDLINE
Multicenter Studies
Dialysis
Creatinine
Language
Randomized Controlled Trials
Heart Failure
Outcome Assessment (Health Care)
Mortality
Serum

Cite this

Zoungas, Sophia ; Ninomiya, Toshiharu ; Huxley, Rachel ; Cass, Alan ; Jardine, Meg ; Gallagher, Martin ; Patel, Anushka ; Vasheghani-Farahani, Ali ; Sadigh, Gelareh ; Perkovic, Vlado. / Systematic review : Sodium bicarbonate treatment regimens for the prevention of contrast-induced nephropathy. In: Annals of Internal Medicine. 2009 ; Vol. 151, No. 9. pp. 631-638.
@article{cc0c29f65d8b44c08aaaa00b26d75ec4,
title = "Systematic review: Sodium bicarbonate treatment regimens for the prevention of contrast-induced nephropathy",
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 (I2 = 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. Metaregression 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.",
author = "Sophia Zoungas and Toshiharu Ninomiya and Rachel Huxley and Alan Cass and Meg Jardine and Martin Gallagher and Anushka Patel and Ali Vasheghani-Farahani and Gelareh Sadigh and Vlado Perkovic",
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Zoungas, S, Ninomiya, T, Huxley, R, Cass, A, Jardine, M, Gallagher, M, Patel, A, Vasheghani-Farahani, A, Sadigh, G & Perkovic, V 2009, 'Systematic review: Sodium bicarbonate treatment regimens for the prevention of contrast-induced nephropathy', Annals of Internal Medicine, vol. 151, no. 9, pp. 631-638. https://doi.org/10.7326/0003-4819-151-9-200911030-00008

Systematic review : Sodium bicarbonate treatment regimens for the prevention of contrast-induced nephropathy. / Zoungas, Sophia; Ninomiya, Toshiharu; Huxley, Rachel; Cass, Alan; Jardine, Meg; Gallagher, Martin; Patel, Anushka; Vasheghani-Farahani, Ali; Sadigh, Gelareh; Perkovic, Vlado.

In: Annals of Internal Medicine, Vol. 151, No. 9, 03.11.2009, p. 631-638.

Research output: Contribution to journalReview articleResearchpeer-review

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T1 - Systematic review

T2 - Sodium bicarbonate treatment regimens for the prevention of contrast-induced nephropathy

AU - Zoungas, Sophia

AU - Ninomiya, Toshiharu

AU - Huxley, Rachel

AU - Cass, Alan

AU - Jardine, Meg

AU - Gallagher, Martin

AU - Patel, Anushka

AU - Vasheghani-Farahani, Ali

AU - Sadigh, Gelareh

AU - Perkovic, Vlado

PY - 2009/11/3

Y1 - 2009/11/3

N2 - 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 (I2 = 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. Metaregression 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.

AB - 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 (I2 = 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. Metaregression 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.

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EP - 638

JO - Annals of Internal Medicine

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