Meta-Analysis of Individual Patient Data of Sodium Bicarbonate and Sodium Chloride for All-Cause Mortality After Coronary Angiography

Abstract

We sought to examine the relation between sodium bicarbonate prophylaxis for contrast-associated nephropathy (CAN) and mortality. We conducted an individual patient data meta-analysis from multiple randomized controlled trials. We obtained individual patient data sets for 7 of 10 eligible trials (2,292 of 2,764 participants). For the remaining 3 trials, time-to-event data were imputed based on follow-up periods described in their original reports. We included all trials that compared periprocedural intravenous sodium bicarbonate to periprocedural intravenous sodium chloride in patients undergoing coronary angiography or other intra-arterial interventions. Included trials were determined by consensus according to predefined eligibility criteria. The primary outcome was all-cause mortality hazard, defined as time from randomization to death. In 10 trials with a total of 2,764 participants, sodium bicarbonate was associated with lower mortality hazard than sodium chloride at 1 year (hazard ratio 0.61, 95% confidence interval [CI] 0.41 to 0.89, p = 0.011). Although periprocedural sodium bicarbonate was associated with a reduction in the incidence of CAN (relative risk 0.75, 95% CI 0.62 to 0.91, p = 0.003), there exists a statistically significant interaction between the effect on mortality and the occurrence of CAN (hazard ratio 5.65, 95% CI 3.58 to 8.92, p <0.001) for up to 1-year mortality. Periprocedural intravenous sodium bicarbonate seems to be associated with a reduction in long-term mortality in patients undergoing coronary angiography or other intra-arterial interventions.

Hydration Strategies for Preventing Contrast-Induced Acute Kidney Injury: A Systematic Review and Bayesian Network Meta-Analysis

“…Most meta-analyses before 2016 [79][80][81][82][83] confirmed that intravenous sodium bicarbonate was more effective than sodium chloride in preventing CI-AKI. However, two recent Journal of Interventional Cardiology 5 Journal of Interventional Cardiology 7 influential studies concluded that intravenous sodium bicarbonate provided no benefit over intravenous sodium chloride in high-risk patients [11] and critically ill patients [12].…”

Contrast-induced acute kidney injury

“…The ones favoring sodium bicarbonate were performed in higher risk patients and with higher event rate. One of the studies 48 showed a reduction in mortality with sodium bicarbonate (hazard ratio 0.61; 95%CI 0.41-0.89; p=0.011), although there was a statistically significant interaction bet ween the effect on mortality and the occurrence of…”

“…While sodium chloride protocols recommend an infusion of 1mL/kg body weight per hour, 12 hours before and 12 hours after administration of the contrast agent, a widely-used sodium bicarbonate protocol 45 consists of 3mL/kg body weight for 1 hour before, and 1mL/kg during contrast exposure, and for 6 hours after the procedure. There are at least six meta-analyses [46][47][48][49][50] comparing sodium bicarbonate and sodium chloride (among other strategies), showing conflicting results. The ones favoring sodium bicarbonate were performed in higher risk patients and with higher event rate.…”