Trivedi H, Nadella R, Szabo A
Division of Nephrology, Medical College of Wisconsin, Milwaukee, WI, USA.
Clin Nephrol. 2010 Oct;74(4):288-96. doi: 10.5414/cnp74288.
Whether hydration with sodium bicarbonate is beneficial for the prevention of contrast-induced nephropathy is uncertain.
We conducted a meta-analysis of trials to evaluate the benefit of sodium bicarbonate solutions for the prevention of contrast-induced nephropathy. Our pre-specified criteria were; 1) adult subjects; 2) English literature 3) randomized trials of individuals assigned to a bicarbonate-containing intravenous solution versus an alternate solution; 4) an end-point that included the incidence of contrast-induced nephropathy 5) a uniform contrast agent. Trials in which certain additional prophylactic agents were allowed or administered in a non-standardized, non-stratified manner were ineligible.
Ten randomized comparisons of sodium bicarbonate versus sodium chloride satisfied study criteria (total n = 1,090). The majority of studies involved subjects undergoing cardiac angiography and a nonionic low osmolar contrast agent was used in most instances. Woolf's test showed no evidence of heterogeneity (p = 0.10; I2 = 39%) and there was no publication bias (p = 0.34). The effect size using the exact Mantel-Haenszel-test revealed an odds ratio (OR) of 0.57 (95% CI: 0.38 - 0.85) for the occurrence of contrast-induced nephropathy with the use of sodium bicarbonate. An analysis restricted to studies that employed hydration without additional prophylactic agents favored sodium bicarbonate to a greater extent (OR 0.33:95% CI: 0.17 - 0.62). However, many trials in this arena may not be considered high-quality studies.
Though inference should be tempered by trial quality issues, given lack of heterogeneity or publication bias the summary effect of randomized trials balanced in important characteristics favors hydration with sodium bicarbonate for the prevention of contrast-induced nephropathy.
碳酸氢钠水化对于预防造影剂肾病是否有益尚不确定。
我们进行了一项试验的荟萃分析，以评估碳酸氢钠溶液预防造影剂肾病的益处。我们预先设定的标准为：1）成年受试者；2）英文文献；3）将个体随机分配至含碳酸氢钠静脉溶液与替代溶液的试验；4）包括造影剂肾病发生率的终点；5）统一的造影剂。允许使用某些额外预防药物或以非标准化、非分层方式给药的试验不符合要求。
碳酸氢钠与氯化钠的10项随机对照满足研究标准（总计n = 1,090）。大多数研究涉及接受心脏血管造影的受试者，且多数情况下使用的是非离子低渗造影剂。Woolf检验未显示异质性证据（p = 0.10；I² = 39%），且无发表偏倚（p = 0.34）。使用精确Mantel-Haenszel检验的效应量显示，使用碳酸氢钠时造影剂肾病发生的优势比（OR）为0.57（95%CI：0.38 - 0.85）。仅限于采用无额外预防药物水化的研究分析更倾向于碳酸氢钠（OR 0.33：95%CI：0.17 - 0.62）。然而，该领域的许多试验可能不被视为高质量研究。
尽管应考虑试验质量问题进行推断，但鉴于缺乏异质性或发表偏倚，在重要特征上平衡的随机试验的汇总效应支持使用碳酸氢钠水化来预防造影剂肾病。
