Hidratação com bicarbonato de sódio não previne a nefropatia de contraste: ensaio clínico multicêntrico

Abstract

Background: Radiographic contrast media exposition can cause acute renal function impairment. There is limited and conflicting evidence that hydration with sodium bicarbonate prevents contrast-induced nephropathy (CIN) in patients undergoing cardiac catheterization.

The efficacy of sodium bicarbonate in preventing contrast-induced nephropathy in patients with pre-existing renal insufficiency: a meta-analysis

“…In eight of these studies, no dialysis was carried out in either group. 11 12 15 16 18 19 22 24 Overall, 14 of 1809 patients treated with sodium bicarbonate compared with 13 of 1824 patients treated with saline underwent dialysis. No statistically significant difference was observed (OR 1.08, 95% CI 0.52 to 2.25; p=0.841) ( figure 3 A).…”

“…Two studies defined CIN as an increase in Scr of 0.5 mg/dL after the procedures. 9 15 However, the remaining two trials differed from the above: CIN was defined in one trial as a decrease in eGFR of 25% within 4 days, and in the other as an absolute increase in Scr of at least 0.3 mg/dL or 50% or urine output of <0.5 mL/kg/h (>6 h) within 5 days. 8 17 We assessed the quality of articles using the new Jadad scale after they were reviewed ( table 2 ).…”

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

“…The primary outcome evaluated in 13 studies was the presence of CIN, defined as a 25% elevation in serum creatinine above the baseline or a 0.5-mg/dL increase during the first 48 hours after the contrast medium was administered 8 , 15 , 16 , 17 , 19 - 22 , 27 , 29 - 32 ; in seven studies, the same definition was used, but CIN was diagnosed up to 5 days post-contrast medium administration 23 , 25 , 26 , 28 , 33 - 35 ; the other two studies used the maximum increase in serum creatinine as an outcome measure 18 , 24 .…”

“…The need for RRT was evaluated in 15 studies and was defined across the board as the need for hemodialysis 48-72 h after exposure to contrast media secondary to acute renal failure 18 - 23 , 28 , 30 - 34 ; in one study, the need for hemodialysis up to 30 days after contrast medium exposure was considered 27 . In 15 studies, mortality was defined as death by any cause within 28 days post procedure 15 , 16 - 19 , 21 - 23 , 26 - 29 , 31 , 32 , 34 .…”

“…The random allocation sequence was judged inappropriate in two studies (9.1%) 24 , 30 given that it was not specified and from reading it can be inferred that there was not any system of randomization. While randomization was effectively reported in 6 studies (27.3%), they failed to specify how they were conducted 17 , 18 , 21 , 28 , 32 , 35 ; in other studies, randomization was deemed adequate. In relation to the concealment of the random sequence, it was deemed adequate in 8 studies (36%) 15 , 18 , 22 - 24 , 28 , 31 , 34 ; in 11(50.0%) it was deemed uncertain given that the type of concealment was not defined and three (13.7%) of the concealments were equally not conducted 8 , 29 , 30 .…”