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.
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机译:摘要背景造影剂肾病是医院内急性肾功能衰竭的主要原因。造影剂的这种副作用导致发病率,死亡率和健康成本增加。尽管预防造影剂引起的肾病的最佳水合策略仍然是一个尚未解决的问题,但在造影剂暴露之前确保足够的水合对预防这种并发症非常有效。先前的荟萃分析和一些近期研究表明,有关碳酸氢钠的保护作用的结果相互矛盾。这项研究的目的是评估生理盐水和碳酸氢钠预防造影剂诱发的肾病的有效性。方法该研究在MEDLINE,EMBASE,Cochrane数据库,International Pharmaceutical Abstracts数据库,ISI Web of Science(直到2008年12月15日)和会议程序中进行了检索,以比较对比生理盐水和碳酸氢钠水合方案治疗对比剂诱发性肾病的随机对照试验。 。随机效应模型用于计算汇总比值比。结果汇集了17个试验,包括2,633名受试者。术前用碳酸氢钠水化与造影剂引起的肾病发生率显着降低有关(比值比为0.52; 95%置信区间为0.34-0.80,P = 0.003)。预防一例造影剂引起的肾病所需的治疗数量为16(95%置信区间10-34)。术后血液透析(P = 0.20)或死亡(P = 0.53)的发生率没有显着差异。结论在最新的荟萃分析中,发现基于碳酸氢钠的水合作用在预防对比剂诱发的肾病方面优于生理盐水。
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