How Strong Is the Evidence for Sodium Bicarbonate to Prevent Contrast-Induced Acute Kidney Injury After Coronary Angiography and Percutaneous Coronary Intervention?
How Strong Is the Evidence for Sodium Bicarbonate to Prevent Contrast-Induced Acute Kidney Injury After Coronary Angiography and Percutaneous Coronary Intervention?
复制标题
DOI：
10.1097/md.0000000000002715
复制
发表时间：
2016-02-01
期刊：
影响因子：
1.6
通讯作者：
Zhang, Shuixing
中科院分区：
文献类型：
--
作者：
Dong, Yuhao;Zhang, Bin;Zhang, Shuixing
碳酸氢钠水化是预防造影剂急性肾损伤(CI-AKI)的策略之一。本研究的目的是确定碳酸氢钠预防冠状动脉造影(CAG)和/或经皮冠状动脉介入治疗(PCI)后CI-AKI的证据有多充分。我们通过PubMed、EMBASE和中央数据库搜索随机对照试验(RCT)，比较碳酸氢钠和氯化钠预防CAG和/或PCI后CI-AKI的效果。计算相对危险度(RR)、标准化平均差值(SMD)或加权平均差值(WMD)，可信区间(CI)为95%。评价了异质性、发表偏倚和研究质量，进行了敏感性分析、累积分析和亚组分析。随机错误的风险通过试验序贯分析(TSA)进行评估。16个随机对照试验(3537名患者)符合资格标准。碳酸氢钠水化治疗在预防急性脑梗塞(RR0.67；95%CI：0.47~0.96，P=0.029)、降低血清肌酐(Smd-0.31 95%CI：-0.55~-0.07，P=0.011)和估计肾小球滤过率(Smd-0.17 95%CI：-0.30~-0.04，P=0.013)方面均有显著疗效。而在透析需求(RR1.11；95%CI：0.60~2.07，P=0.729)、病死率(RR0.71；95%CI：0.41~1.21，P=0.204)和缩短住院天数(WMD1.47；95%CI：-4.14~1.20，P=0.279)方面差异无统计学意义。TSA对CI-AKI发病率的分析结果显示，未达到所需信息量(RIS=6614)，累积z曲线未跨越TSA界限。TSA关于透析需求和死亡率的结果显示，没有达到所需的信息量(RIS分别为170,510和19,516)，累积的z曲线没有跨越任何边界。碳酸氢钠降低CI-AKI发生率的证据令人鼓舞，但需要更多设计良好的随机对照试验才能得出明确的确切结论。
Hydration with sodium bicarbonate is one of the strategies to prevent contrast-induced acute kidney injury (CI-AKI). The purpose of this study was to determine how strong is the evidence for sodium bicarbonate to prevent CI-AKI after coronary angiography (CAG) and/or percutaneous coronary intervention (PCI).We conducted PubMed, EMBASE, and CENTRAL databases to search for randomized controlled trials (RCTs) comparing the efficacy of sodium bicarbonate with sodium chloride to prevent CI-AKI after CAG and/or PCI. Relative risk (RR), standardized mean difference (SMD), or weighted mean difference (WMD) with 95% confidence intervals (CIs) was calculated. Heterogeneity, publication bias, and study quality were evaluated, sensitivity analyses, cumulative analyses, and subgroup analyses were performed. The risk of random errors was assessed by trial sequential analysis (TSA).Sixteen RCTs (3537 patients) met the eligibility criteria. Hydration with sodium bicarbonate showed significant beneficial effects in preventing CI-AKI (RR 0.67; 95% CI: 0.47-0.96, P=0.029), decreasing the change in serum creatinine (SCr) (SMD -0.31 95% CI: -0.55 to -0.07, P=0.011) and estimated glomerular filtration rate (eGFR) (SMD -0.17 95% CI: -0.30 to -0.04, P=0.013). But no significant differences were observed in the requirement for dialysis (RR 1.11; 95% CI: 0.60-2.07, P=0.729), mortality (RR 0.71; 95% CI: 0.41-1.21, P=0.204) and reducing the length of hospital stay (LHS) (WMD -1.47; 95% CI: -4.14 to 1.20, P=0.279). The result of TSA on incidence of CI-AKI showed the required information size (RIS=6614) was not reached and cumulative z curve did not cross TSA boundary. The result of TSA on the requirement for dialysis and mortality demonstrated the required information sizes (RIS=170,510 and 19,516, respectively) were not reached, and the cumulative z-curve did not cross any boundaries.The evidence that sodium bicarbonate reduces the incidence of CI-AKI is encouraging but more well-designed randomized controlled trails are required to allow definitive firm conclusion to be drawn.