Does bicarbonate prevent contrast-induced nephropathy in cardiovascular patients undergoing contrast imaging?: Table 1:

Abstract

A best evidence topic in cardiovascular surgery was written according to a structured protocol. The question addressed was whether administering sodium bicarbonate (NaHCO3) prevents contrast-induced nephropathy (CIN) in cardiovascular patients undergoing contrast imaging. In total, 266 papers were found using the reported search, 16 of which represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. CIN is thought to occur as a result of ischaemic or oxidative injury to the kidney. It is postulated that NaHCO3attenuates this renal damage by alkanizing renal tubular fluid thus reducing the generation of contrast-induced free radicals, which damage the kidney. Of the 16 trials, 15 recruited patients with various degrees of renal dysfunction at baseline. The benefit of using NaHCO3 was demonstrated at all stages of chronic kidney disease. Apart from four studies, 12 studies used low toxicity, low-osmolar contrast. Merten et al. published the first trial of NaHCO3 vs (saline) NaCl in preventing CIN, demonstrated a significantly lower rate in the NaHCO3 group and advocated its widespread use. Subsequent trials using the same regimen have collaborated these results. However, more recently, Gomes et al. concluded that NaHCO3 is not superior to saline-based hydration. Similarly, Brar et al. randomized 323 patients with moderate-to-severe renal insufficiency to receive either an NaHCO3 or an NaCl infusion and observed no difference in CIN rates. Two studies investigated the effects of rapid urine alkanization with bolus injections of NaHCO3 prior to contrast and found significant reductions in CIN rates compared with NaCl-treated groups. One study observed that NaCl is superior to NaHCO3, while all other studies showed a beneficial effect or no difference between NaCl- and NaHCO3-based hydration. The most recent meta-analysis by Jang et al. incorporated 3609 patients across 19 trials and concluded that NaHCO3-based hydration regimens are superior to NaCl-based ones. Based on this review, the authors recommend NaHCO3 alongside an NaCl hydration regimen. The exact regimen will depend on the context within which contrast is being administered and needs further evaluation.

Is Sodium Bicarbonate Therapy Still Up To Date?

“…As for hemofiltration, although it was shown to be useful, it was limited by high cost of implementation and impracticality (27). Dabarca et al suggested that SB should be added to treatment hydration with sodium chloride after examining 266 studies including patients with cardiovascular disease who had direct contrasting agent exposure (28). However, in a meta-analysis of 19 studies, Jang et al investigated 3609 patients and asserted that SB was superior to sodium chloride (29).…”

A novel risk factor of contrast associated acute kidney injury in patients after enhanced computed tomography: a retrospective study

“…Apart from periprocedural hydration, which seems to reduce but not completely prevent the risk of renal injury following radiographic contrast media (RCM) administration ( Jurado-Roman et al., 2015 ; Solomon et al, 1994 ; Eisenberg, Bank & Hedgock, 1981 ), the results of other agents such as dopamine, mannitol, N-acetylcysteine, captoopril and statins are equivocal ( Dabare et al, 2013 ; Weisbord & Palevsky, 2010 ; Verdoodt et al, 2018 ). Since there is no available treatment and even a mild 0.3 mg/dl increase of serum creatinine also associated with a 4.3-fold increase in the odds of death, it is urgent to find the valuable risk factors ( Chertow et al, 2005 ).…”

Obesity as a Risk Factor for Radiographic Contrast-Induced Nephropathy

“… 10 Apart from periprocedural hydration, which seems to reduce but not completely prevent the risk of renal injury following RCM administration, 11 – 13 the results of other agents such as dopamine, mannitol, N-acetylcysteine, and captopril are equivocal. 14 – 20 Statin therapy has also been extensively investigated with some evidence of a protective effect, especially for high-dose statin therapy prior to coronary angiography—particularly in the context of acute coronary syndromes. 21 , 22 However, there is some uncertainty on the impact of statins on renal disease and kidney protection.…”