Meier Pascal, Ko Dennis T, Tamura Akira, Tamhane Umesh, Gurm Hitinder S
University of Michigan School of Medicine, Ann Arbor, Michigan, USA.
BMC Med. 2009 May 13;7:23. doi: 10.1186/1741-7015-7-23.
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.
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.
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.
Sodium bicarbonate-based hydration was found to be superior to normal saline in prevention of contrast-induced nephropathy in this updated meta-analysis.
对比剂肾病是住院患者急性肾衰竭的主要原因。对比剂的这种副作用会导致发病率、死亡率和医疗费用增加。在接触对比剂之前确保充足的水化对预防这种并发症非常有效，尽管预防对比剂肾病的最佳水化策略仍未解决。以前的荟萃分析和最近的几项研究关于碳酸氢钠的保护作用得出了相互矛盾的结果。本研究的目的是评估生理盐水与碳酸氢钠预防对比剂肾病的有效性。
该研究检索了MEDLINE、EMBASE、Cochrane数据库、国际药学文摘数据库、ISI科学网（截至2008年12月15日）以及会议论文集，以查找比较生理盐水与基于碳酸氢钠的水化方案预防对比剂肾病的随机对照试验。采用随机效应模型计算汇总比值比。
共纳入17项试验，包括2633名受试者。术前用碳酸氢钠水化与对比剂肾病发生率显著降低相关（比值比0.52；95%置信区间0.34 - 0.80，P = 0.003）。预防一例对比剂肾病所需治疗人数为16（95%置信区间10 - 34）。术后血液透析率（P = 0.20）或死亡率（P = 0.53）未观察到显著差异。
在这项更新的荟萃分析中，发现基于碳酸氢钠的水化在预防对比剂肾病方面优于生理盐水。
