Bicarbonato de sodio versus solución salina isotónica para la prevención de la nefropatía inducida por medio de contraste: Revisión sistemática y meta-análisis

Abstract

Introduction: Contrast-induced nephropathy is one of the main causes of acute kidney injury and increased hospital-acquired morbidity and mortality. The use of sodium bicarbonate for nephroprotection has emerged as a preventative strategy; however, its efficacy is controversial compared to other strategies, such as hydration using 0.9% saline solution. Objective: To compare the effectiveness of sodium bicarbonate vs. hydration using 0.9% saline solution to prevent contrast-induced acute kidney injury. Methods: A systematic review of studies registered in the Cochrane, Pubmed, Medline, Lilacs, ScielO and Embase databases was conducted. Randomized controlled studies that evaluated the use of 0.9% saline solution vs. sodium bicarbonate to prevent contrast-induced nephropathy were included. Results: A total of 22 studies (5,686 patients) were included. Sodium bicarbonate did not decrease the risk of contrast-induced nephropathy (RD= 0.00; 95% CI= -0.02 to 0.03; p= 0.83; I2= 0%). No significant differences were found in the demand for renal replacement therapy (RD= 0.00; 95% CI= -0.01 to 0-01; I2= 0%; p= 0.99) or in mortality (RD= -0.00; 95% CI= -0.001 to 0.001; I2= 0%; p= 0.51). Conclusions: Sodium bicarbonate administration is not superior to the use of 0.9% saline solution for preventing contrast-induced nephropathy in patients with risk factors, nor is it better at reducing mortality or the need for renal replacement therapy.

Contrast-associated acute kidney injury

“…21 Sodium bicarbonate may have additional therapeutic benefits, including urinary alkalisation and free radical scavenging, but a meta-analysis of 5686 patients showed no clinical benefit of sodium bicarbonate over sodium chloride. 22 We are not aware of any trial that has compared giving a balanced crystalloid fluid with isotonic saline or isotonic sodium bicarbonate, despite the proved benefits of these fluids in other settings.…”

Timeout for Contrast: Using Physician Behavior Modification to Reduce Contrast in the Catheterization Laboratory

“…In patients with chronic kidney disease, it was shown that combined sodium bicarbonate and ascorbic acid administration could prevent CIN after catheterization [10]. However, a meta-analysis comparing sodium bicarbonate to 0.9% saline found that sodium bicarbonate did not reduce the risk of developing CIN [11]. And, while hydration with normal saline has been used as a prevention strategy, few studies have evaluated behavioral modifications of operators in the catheterization laboratory prior to procedures.…”

Amacing

“…76 Finally, large-scale studies consistently fail to find a benefit of sodium bicarbonate over sodium chloride prophylaxis with respect to adverse post-contrast outcomes. 164,165 In short, the AMACING trial results showed that doing nothing was non-inferior to administering intravenous sodium chloride in the bulk of patients, and the current results cannot give direct insight into efficacy of sodium bicarbonate prophylaxis.…”

“…Whereas the recommendation of intravenous hydration as prophylaxis is found in most guidelines, specific protocols vary across guidelines and over time. 70,71,73,75,76,79,136 Taking together the facts that the AMACING trial found not giving prophylaxis to be non-inferior to prophylactic intravenous hydration with sodium chloride, and that large-scale studies find no benefit of sodium bicarbonate over sodium chloride, 164,165 it may well be possible that neither prophylactic strategy is effective at reducing the risk of post contrast adverse outcomes.…”

“…76,165 Finally, large-scale studies fail to find significant differences between sodium bicarbonate and sodium chloride prophylaxis. 164,165 The definition used for PC-AKI in this study is under debate, and updated guidelines recommend using the general definition for acute kidney injury as defined by the KDIGO work group (an increase in serum creatinine greater than 26. mol l or to .…”