Sodium Bicarbonate Versus Sodium Chloride for Preventing Contrast-Associated Acute Kidney Injury in Critically Ill Patients: A Randomized Controlled Trial

Valette, Xavier; Desmeulles, Isabelle; Savary, Benoît; Masson, R; Seguin, Amélie; Sauneuf, Bertrand; Brunet, J.; Verrier, Pierre; Pottier, Véronique; Orabona, Marie; Samba, D.; Viquesnel, Gérald; Lermuzeaux, Mathilde; Hazera, Pascal; Dutheil, Jean-Jacques; Hanouz, Jean‐Luc; Parienti, Jean‐Jacques; Cheyron, Damien du

doi:10.1097/ccm.0000000000002267

Cited by 19 publications

(22 citation statements)

References 43 publications

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“…No study demonstrates protection of pre-emptive volume expansion against CA-AKI in the critically ill. An RCT comparing hydration with isotonic bicarbonate versus normal saline failed to show superiority of either regimen but reported an excessively high rate of CA-AKI of 33% in both groups [100], which may be attributed to severity of illness in this critically ill cohort. Importantly, in patients with chronic kidney disease (CKD) undergoing percutaneous coronary intervention (PCI), hydration volumes above 11 ml/kg body weight (BW) were associated with continuously increased rates of AKI, requirement for RRT and mortality.…”

Section: Volume Expansionmentioning

confidence: 99%

Prevention of acute kidney injury and protection of renal function in the intensive care unit: update 2017

et al. 2017

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BackgroundAcute kidney injury (AKI) in the intensive care unit is associated with significant mortality and morbidity.ObjectivesTo determine and update previous recommendations for the prevention of AKI, specifically the role of fluids, diuretics, inotropes, vasopressors/vasodilators, hormonal and nutritional interventions, sedatives, statins, remote ischaemic preconditioning and care bundles.MethodA systematic search of the literature was performed for studies published between 1966 and March 2017 using these potential protective strategies in adult patients at risk of AKI. The following clinical conditions were considered: major surgery, critical illness, sepsis, shock, exposure to potentially nephrotoxic drugs and radiocontrast. Clinical endpoints included incidence or grade of AKI, the need for renal replacement therapy and mortality. Studies were graded according to the international GRADE system.ResultsWe formulated 12 recommendations, 13 suggestions and seven best practice statements. The few strong recommendations with high-level evidence are mostly against the intervention in question (starches, low-dose dopamine, statins in cardiac surgery). Strong recommendations with lower-level evidence include controlled fluid resuscitation with crystalloids, avoiding fluid overload, titration of norepinephrine to a target MAP of 65–70 mmHg (unless chronic hypertension) and not using diuretics or levosimendan for kidney protection solely.ConclusionThe results of recent randomised controlled trials have allowed the formulation of new recommendations and/or increase the strength of previous recommendations. On the other hand, in many domains the available evidence remains insufficient, resulting from the limited quality of the clinical trials and the poor reporting of kidney outcomes.Electronic supplementary materialThe online version of this article (doi:10.1007/s00134-017-4832-y) contains supplementary material, which is available to authorized users.

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Section: Volume Expansionmentioning

confidence: 99%

Prevention of acute kidney injury and protection of renal function in the intensive care unit: update 2017

et al. 2017

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“…No RCTs, systematic reviews, or observational studies on alkalinisation compared to none were identified in our predefined population. A French multicenter RCT assessed sodium bicarbonate vs saline in the prevention of contrast‐induced AKI in critically ill patients in general and found no difference in patient‐important outcomes . In the PRESERVE trial 5177 high‐risk patients bound for angiography were randomised to 5 days of oral acetylcysteine and iv saline or intravenous bicarbonate using a 2‐by‐2 factorial design .…”

Section: Resultsmentioning

confidence: 99%

“…Also, we were not able to identify other trustworthy clinical practice guidelines on the topic. Our guideline holds limitations too: Our guideline is based on a very limited number of human observational studies of poor methodological quality, often with the use of “bundle‐therapies” including concomitant use of alkalinisation and mannitol, other diuretics or fluids . This made it difficult to discern treatment effects of individual therapies.…”

Section: Discussionmentioning

confidence: 99%

Prevention of rhabdomyolysis‐induced acute kidney injury – A DASAIM/DSIT clinical practice guideline

Michelsen

Cordtz

Liboriussen

et al. 2019

Acta Anaesthesiol Scand

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Background: Rhabdomyolysis-induced acute kidney injury (AKI) is a common and serious condition. We aimed to summarise the available evidence on this topic and provide recommendations according to current standards for trustworthy guidelines. Methods: This guideline was developed using Grading of RecommendationsAssessment, Development, and Evaluation (GRADE). The following preventive interventions were assessed: (a) fluids, (b) diuretics, (c) alkalinisation, (d) antioxidants, and (e) renal replacement therapy. Exclusively patient-important outcomes were assessed. Results:We suggest using early rather than late fluid resuscitation (weak recommendation, very low quality of evidence). We suggest using crystalloids rather than colloids (weak recommendation, low quality of evidence). We suggest against routine use of loop diuretics as compared to none (weak recommendation, very low quality of evidence). We suggest against use of mannitol as compared to none (weak recommendation, very low quality of evidence). We suggest against routine use of any diuretic as compared to none (weak recommendation, very low quality of evidence). We suggest against routine use of alkalinisation with sodium bicarbonate as compared to none (weak recommendation, low quality of evidence). We suggest against the routine use of any alkalinisation as compared to none (weak recommendation, low quality of evidence). We suggest against routine use of renal replacement therapy as compared to none (weak recommendation, low quality of evidence). For the remaining PICO questions, no recommendations were issued. Conclusion:The quantity and quality of evidence supporting preventive interventions for rhabdomyolysis-induced AKI is low/very low. We were able to issue eight weak recommendations and no strong recommendations.

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“…Most meta-analyses before 2016 [79][80][81][82][83] confirmed that intravenous sodium bicarbonate was more effective than sodium chloride in preventing CI-AKI. However, two recent Journal of Interventional Cardiology 5 Journal of Interventional Cardiology 7 influential studies concluded that intravenous sodium bicarbonate provided no benefit over intravenous sodium chloride in high-risk patients [11] and critically ill patients [12]. Our NMA included 37 studies that compared intravenous sodium chloride with sodium bicarbonate, and our results also indicated that intravenous sodium bicarbonate led to a reduced risk for CI-AKI, although the effect size was small (OR [95% CI]: 0.74 [0.57, 0.93]).…”

Section: Discussionmentioning

confidence: 99%

“…Weisbord et al [11] enrolled 5177 high-risk patients and reported no benefit of intravenous sodium bicarbonate relative to normal saline. Another RCT [12] concluded that the benefit of sodium bicarbonate was marginal relative to isotonic sodium chloride for preventing CI-AKI among critically ill patients. However, other studies indicated that the Renal-Guard System [13][14][15][16] and hemodynamic guided hydration [17][18][19] were safe and effective in preventing CI-AKI.…”

Section: Introductionmentioning

confidence: 99%

Hydration Strategies for Preventing Contrast-Induced Acute Kidney Injury: A Systematic Review and Bayesian Network Meta-Analysis

Cai

Jing

Zhang

et al. 2020

Journal of Interventional Cardiology

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Aims. Many previous studies have examined the effect of different hydration strategies on prevention of contrast-induced acute kidney injury (CI-AKI), but the optimal strategy is unknown. We performed a network meta-analysis (NWM) of these previous studies to identify the optimal strategy. Methods and Results. Web of Science, PubMed, OVID Medline, and Cochrane Library were searched from their inception dates to September 30, 2018. Randomized controlled trials (RCTs) were selected based on strict inclusion criteria, and a Bayesian NWM was performed using WinBUGS V.1.4.3. We finally analyzed 60 eligible RCTs, which examined 21,293 patients and 2232 CI-AKI events. Compared to intravenous 0.9% sodium chloride (reference), intravenous sodium bicarbonate (OR [95% CI]: 0.74 [0.57, 0.93]), hemodynamic guided hydration (0.41 [0.18, 0.93]), and RenalGuard guided hydration (0.32 [0.14, 0.70]) significantly reduced the occurrence of CI-AKI. Oral hydration and intravenous 0.9% sodium chloride were each noninferior to no hydration in preventing CI-AKI. Intravenous 0.9% sodium chloride, sodium bicarbonate, and hemodynamic guided hydration were each noninferior to oral hydration in preventing CI-AKI. Based on surface under the cumulative ranking curve values, the RenalGuard system was best (0.974) and hemodynamic guided hydration was second best (0.849). Conclusion. There was substantial evidence to support the use of RenalGuard or hemodynamic guided hydration for preventing CI-AKI in high-risk patients, especially those with chronic kidney disease or cardiac dysfunction.

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Sodium Bicarbonate Versus Sodium Chloride for Preventing Contrast-Associated Acute Kidney Injury in Critically Ill Patients: A Randomized Controlled Trial

Abstract: Except for urinary pH, none of the outcomes differed between the two groups. Among ICU patients with stable renal function, the benefit of using sodium bicarbonate rather than isotonic sodium chloride for preventing contrast-associated acute kidney injury is marginal, if any.

Cited by 19 publications

References 43 publications

Prevention of acute kidney injury and protection of renal function in the intensive care unit: update 2017

Prevention of acute kidney injury and protection of renal function in the intensive care unit: update 2017

Prevention of rhabdomyolysis‐induced acute kidney injury – A DASAIM/DSIT clinical practice guideline

Hydration Strategies for Preventing Contrast-Induced Acute Kidney Injury: A Systematic Review and Bayesian Network Meta-Analysis

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