American Journal of Kidney Diseases
Volume 53, Issue 4 , Pages 617-627 , April 2009

Sodium Bicarbonate Therapy for Prevention of Contrast-Induced Nephropathy: A Systematic Review and Meta-analysis

  • Sankar D. Navaneethan, MD, MPH

      Affiliations

    • Department of Nephrology and Hypertension, Cleveland Clinic, Cleveland, OH
    • Corresponding Author InformationAddress correspondence to Sankar D. Navaneethan, MD, MPH, Department of Nephrology and Hypertension, Cleveland Clinic, 9500 Euclid Ave, A51, Cleveland, OH 44195
  • ,
  • Sonal Singh, MD, MPH

      Affiliations

    • Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC
  • ,
  • Suresh Appasamy, MD

      Affiliations

    • Department of Medicine, New York Downtown Hospital, New York
  • ,
  • Richard E. Wing, MD

      Affiliations

    • Nephrology Unit, University of Rochester School of Medicine and Dentistry, Rochester, NY
  • ,
  • Ashwini R. Sehgal, MD

      Affiliations

    • Division of Nephrology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH

Received 24 April 2008 ,Accepted 27 August 2008.

References 

  1. Nash K, Hafeez A, Hou S. Hospital-acquired renal insufficiency. Am J Kidney Dis. 2002;39:930–936
  2. Liss P, Persson PB, Hansell P, Lagerqvist B. Renal failure in 57 925 patients undergoing coronary procedures using iso-osmolar or low-osmolar contrast media. Kidney Int. 2006;70:1811–1817
  3. Gruberg L, Mintz GS, Mehran R, et al. The prognostic implications of further renal function deterioration within 48 h of interventional coronary procedures in patients with pre-existent chronic renal insufficiency. J Am Coll Cardiol. 2000;36:1542–1548
  4. Rudnick M, Feldman H. Contrast-induced nephropathy: What are the true clinical consequences?. Clin J Am Soc Nephrol. 2008;3:263–272
  5. McCullough PA, Wolyn R, Rocher LL, Levin RN, O'Neill WW. Acute renal failure after coronary intervention: Incidence, risk factors, and relationship to mortality. Am J Med. 1997;103:368–375
  6. Aronow HD, Peyser PA, Eagle KA, et al. Predictors of length of stay after coronary stenting. Am Heart J. 2001;142:799–805
  7. Van Praet JT, De Vriese AS. Prevention of contrast-induced nephropathy: A critical review. Curr Opin Nephrol Hypertens. 2007;16:336–347
  8. Dussol B, Morange S, Loundoun A, Auquier P, Berland Y. A randomized trial of saline hydration to prevent contrast nephropathy in chronic renal failure patients. Nephrol Dial Transplant. 2006;21:2120–2126
  9. McCullough PA, Bertrand ME, Brinker JA, Stacul F. A meta-analysis of the renal safety of isosmolar iodixanol compared with low-osmolar contrast media. J Am Coll Cardiol. 2006;48:692–699
  10. Alonso A, Lau J, Jaber BL, Weintraub A, Sarnak MJ. Prevention of radiocontrast nephropathy with N-acetylcysteine in patients with chronic kidney disease: A meta-analysis of randomized, controlled trials. Am J Kidney Dis. 2004;43:1–9
  11. Kshirsagar AV, Poole C, Mottl A, et al. N-Acetylcysteine for the prevention of radiocontrast-induced nephropathy: A meta-analysis of prospective controlled trials. J Am Soc Nephrol. 2004;15:761–769
  12. Pannu N, Manns B, Lee H, Tonelli M. Systematic review of the impact of N-acetylcysteine on contrast nephropathy. Kidney Int. 2004;65:1366–1374
  13. Mueller C. Prevention of contrast-induced nephropathy with volume supplementation. Kidney Int Suppl. 2006;100:S16–S19
  14. Merten GJ, Burgess WP, Gray LV, et al. Prevention of contrast-induced nephropathy with sodium bicarbonate: A randomized controlled trial. JAMA. 2004;291:2328–2334
  15. Masuda M, Yamada T, Mine T, et al. Comparison of usefulness of sodium bicarbonate versus sodium chloride to prevent contrast-induced nephropathy in patients undergoing an emergent coronary procedure. Am J Cardiol. 2007;100:781–786
  16. Ozcan EE, Guneri S, Akdeniz B, et al. Sodium bicarbonate, N-acetylcysteine, and saline for prevention of radio contrast-induced nephropathy (A comparison of 3 regimens for protecting contrast-induced nephropathy in patients undergoing coronary procedures. A single-center prospective controlled trial). Am Heart J. 2007;154:539–544
  17. Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: Is blinding necessary?. Control Clin Trials. 1996;17:1–12
  18. DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986;7:177–188
  19. Higgins J, Thompson S, Deeks J, Altman D. Measuring inconsistency in meta-analyses. BMJ. 2003;327:557–560
  20. Recio-Mayoral A, Chaparro M, Prado B, et al. The reno-protective effect of hydration with sodium bicarbonate plus N-acetylcysteine in patients undergoing emergency percutaneous coronary intervention: The RENO Study. J Am Coll Cardiol. 2007;49:1283–1288
  21. Briguori C, Airoldi F, D'Andrea D, et al. Renal Insufficiency Following Contrast Media Administration Trial (REMEDIAL): A randomized comparison of 3 preventive strategies. Circulation. 2007;115:1211–1217
  22. Kim GH, Kim KS, Shin JH, Lee CH, Kang CM. Hydration with sodium bicarbonate for the prevention of radio contrast-induced nephropathy. Nephrol Dial Transplant. 2007;22:vi 49;(suppl 6; abstr)
  23. Lin M, Sabeti M, Iskander E, Malhotra N, Pham PTT, Pham PCT. Prevention of contrast nephropathy with sodium bicarbonate. J Am Soc Nephrol. 2007;18:959A;(abstr)
  24. Chen H, Wu H, He Q, Chen H. Comparison of sodium bicarbonate and sodium chloride as strategies for preventing contrast nephropathy. J Am Soc Nephrol. 2007;18:817A;(abstr)
  25. Heguilen R, Liste A, Rosende G, et al. Prevention of contrast-induced nephropathy: volume expansion, N-acetylcysteine or both? (Results from a pilot study). Nephrol Dial Transplant. 2007;22:vi 54;(suppl 6; abstr)
  26. Shaikh F, Maddikunta R, Museitif R, et al. A prospective randomised controlled trial comparing normal saline and sodium bicarbonate with or without N-acetylcysteine for prevention of contrast-induced nephropathy. Transcatheter Cardiovasc Ther. 2007;100:S122–S125(abstr 308)
  27. Saidin R, Zainudin S, Kong NCT, et al. Intravenous sodium bicarbonate versus normal saline infusion as prophylaxis against contrast nephropathy in patients with chronic kidney disease undergoing coronary angiography or angioplasty. J Am Soc Nephrol. 2006;17:766A;(abstr)
  28. Brar SS, Shen AY, Jorgensen MB, et al. Sodium bicarbonate vs sodium chloride for the prevention of contrast medium–induced nephropathy in patients undergoing coronary angiography. JAMA. 2008;300:1038–1046
  29. Heyman SN, Brezis M, Epstein FH, Spokes K, Silva P, Rosen S. Early renal medullary hypoxic injury from radiocontrast and indomethacin. Kidney Int. 1991;40:632–642
  30. Heyman SN, Rosen S, Brezis M. Radiocontrast nephropathy: A paradigm for the synergism between toxic and hypoxic insults in the kidney. Exp Nephrol. 1994;2:153–157
  31. Katholi RE, Woods T, Taylor JG, et al. Oxygen free radicals and contrast nephropathy. Am J Kidney Dis. 1998;32:64–71
  32. Dangas G, Iakovou I, Nikolsky E, et al. Contrast-induced nephropathy after percutaneous coronary interventions in relation to chronic kidney disease and hemodynamic variables. Am J Cardiol. 2005;95:13–19
  33. Bakris GL, Lass N, Gaber AO, Jones JD, Burnett JC. Radiocontrast medium-induced declines in renal function: A role for oxygen free radicals. Am J Physiol. 1990;175:57–60
  34. Atkins JL. Effect of sodium bicarbonate preloading on ischemic renal failure. Nephron. 1986;44:70–74
  35. Lindinger MI, Franklin TW, Lands LC, Pedersen PK, Welsh DG, Heigenhauser GJ. NaHCO3 and KHCO3 ingestion rapidly increases renal electrolyte excretion in humans. J Appl Physiol. 2000;88:540–550
  36. Coca SG, Peixoto AJ, Garg AX, Krumholz HM, Parikh CR. The prognostic importance of a small acute decrement in kidney function in hospitalized patients: A systematic review and meta-analysis. Am J Kidney Dis. 2007;50:712–720
  37. Goldberg R, Dennen P. Long-term outcomes of acute kidney injury. Adv Chronic Kidney Dis. 2008;15:297–307
  38. Chertow GM, Burdick E, Honour M, Bonventre JV, Bates DW. Acute kidney injury, mortality, length of stay, and costs in hospitalized patients. J Am Soc Nephrol. 2005;16:3365–3370
  39. Weisbord SD, Chen H, Stone RA, et al. Associations of increases in serum creatinine with mortality and length of hospital stay after coronary angiography. J Am Soc Nephrol. 2006;17:2871–2877
  40. Xue JL, Daniels F, Star RA, et al. Incidence and mortality of acute renal failure in Medicare beneficiaries, 1992 to 2001. J Am Soc Nephrol. 2006;17:1135–1142
  41. From AM, Bartholmai BJ, Williams AW, Cha SS, Pflueger A, McDonald FS. Sodium bicarbonate is associated with an increased incidence of contrast nephropathy: A retrospective cohort study of 7977 patients at Mayo Clinic. Clin J Am Soc Nephrol. 2008;3:10–18
  42. Bersin RM, Chatterjee K, Arieff AI. Metabolic and hemodynamic consequences of sodium bicarbonate administration in patients with heart disease. Am J Med. 1989;87:7–14
  43. Kelly AM, Dwamena B, Cronin P, Bernstein SJ, Carlos RC. Meta-analysis: Effectiveness of drugs for preventing contrast-induced nephropathy. Ann Intern Med. 2008;148:284–294
  44. Cruz DN, Perazella MA, Bellomo R, et al. Extracorporeal blood purification therapies for prevention of radiocontrast-induced nephropathy: A systematic review. Am J Kidney Dis. 2006;48:361–371
  45. Solomon R. Contrast media nephropathy—How to diagnose and how to prevent?. Nephrol Dial Transplant. 2007;22:1812–1815
  46. http://www.clinicaltrials.gov/ct2/results?term=sodium+bicarbonate+and+contrast+nephropathyAccessed July 9, 2008

 Originally published online as doi:10.1053/j.ajkd.2008.08.033 on November 25, 2008.

PII: S0272-6386(08)01431-5

doi: 10.1053/j.ajkd.2008.08.033

American Journal of Kidney Diseases
Volume 53, Issue 4 , Pages 617-627 , April 2009