Kanbay Mehmet, Covic Adrian, Coca Steven G, Turgut Faruk, Akcay Ali, Parikh Chirag R
Department of Internal Medicine, Section of Nephrology, Fatih University School of Medicine, Gokkusagi Mahallesi, Cevizlidere/Cankaya, Ankara, Turkey.
Int Urol Nephrol. 2009;41(3):617-27. doi: 10.1007/s11255-009-9569-2. Epub 2009 Apr 25.
Contrast-induced nephropathy (CIN) is a common cause of acute kidney injury. Several preventive therapies for this injury have been tested; however, there is still no consensus on the optimal protocol.
We performed a systematic search of the National Library of Medicine and the Cochrane Library databases from January 1985 to November 2008 to identify randomized controlled studies examining sodium bicarbonate as a preventive measure for CIN in humans. We also reviewed conference abstracts from cardiology nephrology and radiology meetings from 2004 to 2008. A change in serum creatinine levels defined by an absolute (>or=0.5 mg/dl) or percentage (>or=25%) increase in the serum creatinine level is defined as CIN. The primary outcome measure was the incidence of CIN, and the secondary outcome measures were: change in serum creatinine from baseline, requirement for renal replacement therapy and death.
Seventeen randomized controlled trials have investigated the role of sodium bicarbonate for prophylaxis of CIN. The overall incidence of CIN was 11.3%. Using the results from all 17 studies that compared bicarbonate versus saline, the pooled relative risk of developing CIN was 0.54 (95% CI, 0.36-0.83) in the intervention arm, indicating a significant benefit from sodium bicarbonate. The pooled relative risk of CIN was 0.57 (95% CI, 0.35-0.95) when we analyzed for the studies that compared the effects sodium bicarbonate to NAC on development of CIN. There was no difference in the rates of requirement for renal replacement therapy and death.
The use of sodium bicarbonate appears to reduce the incidence of CIN when compared to other preventive strategies for CIN without a significant difference in the requirement of renal replacement therapy and mortality. There are study heterogeneity and publication biases. Further adequately powered randomized controlled studies are needed to determine whether sodium bicarbonate will reduce the clinically meaningful outcomes (e.g., need for dialysis or death) and optimal hydration strategy in high-risk patients.
造影剂肾病（CIN）是急性肾损伤的常见原因。已经对该损伤的几种预防性治疗方法进行了测试；然而，关于最佳方案仍未达成共识。
我们对1985年1月至2008年11月期间美国国立医学图书馆和考克兰图书馆数据库进行了系统检索，以确定将碳酸氢钠作为人类CIN预防措施的随机对照研究。我们还回顾了2004年至2008年心脏病学、肾脏病学和放射学会议的摘要。血清肌酐水平绝对升高（≥0.5mg/dl）或百分比升高（≥25%）定义的血清肌酐水平变化被定义为CIN。主要结局指标是CIN的发生率，次要结局指标是：血清肌酐相对于基线的变化、肾脏替代治疗的需求和死亡。
17项随机对照试验研究了碳酸氢钠在预防CIN中的作用。CIN的总体发生率为11.3%。使用所有17项比较碳酸氢盐与生理盐水的研究结果，干预组发生CIN的合并相对风险为0.54（95%CI，0.36 - 0.83），表明碳酸氢钠有显著益处。当我们分析比较碳酸氢钠与N - 乙酰半胱氨酸对CIN发生影响的研究时，CIN的合并相对风险为0.57（95%CI，0.35 - 0.95）。肾脏替代治疗需求率和死亡率没有差异。
与其他CIN预防策略相比，使用碳酸氢钠似乎可降低CIN的发生率，且在肾脏替代治疗需求和死亡率方面无显著差异。存在研究异质性和发表偏倚。需要进一步开展有足够样本量的随机对照研究，以确定碳酸氢钠是否会降低高危患者的临床有意义结局（如透析需求或死亡）以及最佳水化策略。
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