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Open Access Highly Accessed Research article

Sodium bicarbonate-based hydration prevents contrast-induced nephropathy: a meta-analysis

Pascal Meier1, Dennis T Ko2, Akira Tamura3, Umesh Tamhane1 and Hitinder S Gurm14*

Author Affiliations

1 University of Michigan School of Medicine, Ann Arbor, Michigan, USA

2 Institute for Clinical Evaluative Sciences, University of Toronto, Ontario, Canada

3 Internal Medicine 2, Oita University, Yufu, Japan

4 VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA

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BMC Medicine 2009, 7:23  doi:10.1186/1741-7015-7-23

Published: 13 May 2009

Abstract

Background

Contrast-induced nephropathy is the leading cause of in-hospital acute renal failure. This side effect of contrast agents leads to increased morbidity, mortality, and health costs. Ensuring adequate hydration prior to contrast exposure is highly effective at preventing this complication, although the optimal hydration strategy to prevent contrast-induced nephropathy still remains an unresolved issue. Former meta-analyses and several recent studies have shown conflicting results regarding the protective effect of sodium bicarbonate. The objective of this study was to assess the effectiveness of normal saline versus sodium bicarbonate for prevention of contrast-induced nephropathy.

Methods

The study searched MEDLINE, EMBASE, Cochrane databases, International Pharmaceutical Abstracts database, ISI Web of Science (until 15 December 2008), and conference proceedings for randomized controlled trials that compared normal saline with sodium bicarbonate-based hydration regimen regarding contrast-induced nephropathy. Random-effects models were used to calculate summary odds ratios.

Results

A total of 17 trials including 2,633 subjects were pooled. Pre-procedural hydration with sodium bicarbonate was associated with a significant decrease in the rate of contrast-induced nephropathy (odds ratios 0.52; 95% confidence interval 0.34–0.80, P = 0.003). Number needed to treat to prevent one case of contrast-induced nephropathy was 16 (95% confidence interval 10–34). No significant differences in the rates of post-procedure hemodialysis (P = 0.20) or death (P = 0.53) was observed.

Conclusion

Sodium bicarbonate-based hydration was found to be superior to normal saline in prevention of contrast-induced nephropathy in this updated meta-analysis.