Sodium Bicarbonate Plus N-Acetylcysteine Prophylaxis: A Meta-Analysis

doi:10.1016/j.jcin.2009.07.015

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J Am Coll Cardiol Intv, 2009; 2:1116-1124, doi:10.1016/j.jcin.2009.07.015
© 2009 by the American College of Cardiology Foundation

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Sodium Bicarbonate Plus N-Acetylcysteine Prophylaxis

A Meta-Analysis

Jeremiah R. Brown, PhD^_*^,^,_*, Clay A. Block, MD, David J. Malenka, MD, Gerald T. O'Connor, PhD, ScD^_*, Anton C. Schoolwerth, MD, MSHA, Craig A. Thompson, MD, MMSc

^_* The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire
Section of Nephrology and Hypertension, Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
Section of Cardiology, Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
Department of Invasive Cardiology and Vascular Medicine, Yale University School of Medicine, New Haven, Connecticut

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Figure 1 Study Selection

RCT = randomized controlled trial.

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Figure 2 CI-AKI

Individual randomized controlled trials are listed in order by year of publication. Outcome is contrast-induced acute kidney injury (CI-AKI). (A) CI-AKI (25% relative increase in serum creatinine from baseline). (B) CI-AKI ( $≥$ 0.5 mg/dl increase in serum creatinine from baseline). (C) CI-AKI ( $≥$ 25% or $≥$ 0.5 mg/dl increase in serum creatinine from baseline). The size of each square denotes the weight of each trial's relative risk (RR) in calculating the combined RR. The diamond represents the combined RR at the center; opposing points of the diamond represent the 95% confidence intervals (CIs). Treatment: N-acetylcysteine (NAC) plus sodium bicarbonate (Bicarb). AA = N-acetylcysteine plus ascorbic acid; NS = normal saline.

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Figure 3 Renal Failure Requiring Dialysis

Individual randomized controlled trials are listed in order by year of publication. Outcome is dialysis. The size of each square denotes the weight of each trial's RR in calculating the combined RR. The diamond represents the combined RR at the center; opposing points of the diamond represent the 95% CIs. Treatment: NAC plus Bicarb. Abbreviations as in Figure 2.