Zapata-Chica Carlos Andres, Bello Marquez Diana, Serna-Higuita Lina Maria, Nieto-Ríos John Fredy, Casas-Arroyave Fabian David, Donado-Gómez Jorge Hernando
Pediatric Nephrologist. The University of Antioquia, Medellin, Colombia .
Pediatric Nephrologist. Pablo Tobón Uribe Hospital, The University of Antioquia. Medellin, Colombia.
Colomb Med (Cali). 2015 Sep 30;46(3):90-103.
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.
To compare the effectiveness of sodium bicarbonate vs. hydration using 0.9% saline solution to prevent contrast-induced acute kidney injury.
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.
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; I(2)= 0%). No significant differences were found in the demand for renal replacement therapy (RD= 0.00; 95% CI= -0.01 to 0-01; I(2)= 0%; p= 0.99) or in mortality (RD= -0.00; 95% CI= -0.001 to 0.001; I(2)= 0%; p= 0.51).
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.
对比剂肾病是急性肾损伤以及医院获得性发病率和死亡率增加的主要原因之一。使用碳酸氢钠进行肾脏保护已成为一种预防策略；然而，与其他策略（如使用0.9%盐水溶液进行水化）相比，其疗效存在争议。
比较碳酸氢钠与使用0.9%盐水溶液进行水化在预防对比剂诱导的急性肾损伤方面的有效性。
对Cochrane、PubMed、Medline、LILACS、SCIELO和Embase数据库中注册的研究进行系统评价。纳入评估使用0.9%盐水溶液与碳酸氢钠预防对比剂肾病的随机对照研究。
共纳入22项研究（5686例患者）。碳酸氢钠并未降低对比剂肾病的风险（风险差值=0.00；95%置信区间=-0.02至0.03；p=0.83；I²=0%）。在肾脏替代治疗需求方面未发现显著差异（风险差值=0.00；95%置信区间=-0.01至0.01；I²=0%；p=0.99），在死亡率方面也未发现显著差异（风险差值=-0.00；95%置信区间=-0.001至0.001；I²=0%；p=0.51）。
对于有危险因素的患者，给予碳酸氢钠在预防对比剂肾病方面并不优于使用0.9%盐水溶液，在降低死亡率或肾脏替代治疗需求方面也没有更好的效果。
