Abstract: FR-PO097
Effects of Sodium Bicarbonate on Clinical Outcomes in CKD Patients with Contrast-Associated AKI (CA-AKI): A Meta-Analysis on Randomized Controlled Trials (RCTs)
Session Information
- AKI: Epidemiology, Risk Factors, Prevention - I
November 03, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 101 AKI: Epidemiology, Risk Factors, and Prevention
Author
- Lin, Yen Chung, Taipei Medical University Hospital, Taipei, Taiwan
Background
Contrast Associated Acute kidney Injury (CA-AKI) has been linked to the causal effect in a small increase of creatinine without serious adverse outcomes. However, this transient decrement in kidney function may associate with serious adverse outcomes such as dialysis or mortality. Intravenous fluid volume expansion with sodium bicarbonate (NaBiC) were highly recommended for prevention of CA-AKI in KDIGO guidelines. However, the independent role of NaBiC in CA-AKI is not fully explored especially on patients with chronic kidney disease (CKD).
Methods
The randomized controlled trials with NaBiC supplement were compared to that of hydration in CKD patient with CA-AKI were surveyed. Electronic databases: Pubmed, Embase, Web of science, and Cochrane library were searched with predefined key words/MeSH terms to identified relevant studies. In addition, reference lists of included studies were screened manually. We conducted meta-analysis by using random effects model. The results were expressed as risk ratio for categorical outcomes with 95% confidence interval and mean difference with 95% confidence interval for continuous outcomes.
Results
A total 25 studies were included in our final analysis after screened with predefined criteria, including 4396 patient with CKD. The risk ratio of CA-AKI when comparing NaBiC to hydration is 0.74 [95% CI: 0.56, 0.97] in subgroup of early CKD (eGFR between 45-60ml/min). However, the Risk ratio of dialysis and mortality are 0.97 [95% CI: 0.46, 2.03] and 0.90 [95% CI: 0.67, 1.20] in all population, respectively. Mean difference of creatinine between NaBiC group and hydration group within 24 hours, 48 hours and 72 hours are -0.04 [95% CI: -0.17, 0.10] mg/dl, -0.02 [95% CI: -0.12, 0.08] and -0.44 [95% CI: -0.72, -0.16] mg/dl, respectively. Mean difference of eGFR within 24 hours, 48 hours and 72 hours between NaBiC and hydration group is 0.06 [95% CI: -0.23, 0.35], 0.12 [95% CI: -0.06, 0.30] and 0.67 [95%CI: 0.34, 1.01] ml/min/1.73m2. Mean difference of hospital stay length is -0.55 [95% CI: -1.56, 0.47] days between NaBiC and hydration group. The funnel plot showed no bias.
Conclusion
In compared to intravenous fluid volume expansion, sodium bicarbonate may benefit in eGFR in early CKD patients, however, in regards to mortality, dialysis or hospital stay, NaBiC supplement showed no additional advantages in patients with CKD.