Effectiveness of contrast-associated acute kidney injury prevention methods; a systematic review and network meta-analysis

Abstract

BackgroundDifferent methods to prevent contrast-associated acute kidney injury (CA-AKI) have been proposed in recent years. We performed a mixed treatment comparison to evaluate and rank suggested interventions.MethodsA comprehensive Systematic review and a Bayesian network meta-analysis of randomised controlled trials was completed. Results were tabulated and graphically represented using a network diagram; forest plots and league tables were shown to rank treatments by the surface under the cumulative ranking curve (SUCRA). A stacked bar chart rankogram was generated. We performed main analysis with 200 RCTs and three analyses according to contrast media and high or normal baseline renal profile that includes 173, 112 & 60 RCTs respectively.ResultsWe have included 200 trials with 42,273 patients and 44 interventions. The primary outcome was CI-AKI, defined as ≥25% relative increase or ≥ 0.5 mg/dl increase from baseline creatinine one to 5 days post contrast exposure. The top ranked interventions through different analyses were Allopurinol, Prostaglandin E1 (PGE1) & Oxygen (0.9647, 0.7809 & 0.7527 in the main analysis). Comparatively, reference treatment intravenous hydration was ranked lower but better than Placebo (0.3124 VS 0.2694 in the main analysis).ConclusionMultiple CA-AKI preventive interventions have been tested in RCTs. This network evaluates data for all the explored options. The results suggest that some options (particularly allopurinol, PGE1 & Oxygen) deserve further evaluation in a larger well-designed RCTs.Electronic supplementary materialThe online version of this article (10.1186/s12882-018-1113-0) contains supplementary material, which is available to authorized users.

Iodinated contrast medium: Is there a re(n)al problem? A clinical vignette-based review

“…More than 42,000 patients were enrolled in these RCTs. N-acetylcysteine (> 6000 patients), intravenous hydration (> 5000), sodium bicarbonate (≈ 3400), statins (> 3000) were the most tested among more than 40 tested interventions [42]. For each prevention method, conflicting conclusions were reported, from one study to another and even from one meta-analysis to another [43][44][45].…”

“…Almost 200 randomized controlled trials (RCTs) tested pharmacological prevention of CA-AKI [ 42 ]. More than 42,000 patients were enrolled in these RCTs.…”

Contrast-Induced Nephropathy in patients submitted to percutaneous coronary intervention: an integrative review

“…It was once believed that the use of acetylcysteine could provide renal protection, especially when manipulated in conjunction with other elements such as hydration, patients with mild kidney injury and the type and volume of contrast used (35) ; however, current randomized and well-designed studies, guidelines and meta-analyzes have shown that acetylcysteine does not decrease CIN incidence in patients with glomerular filtration rate <60 ml/ min undergoing percutaneous coronary procedures (28,(36)(37) . It can be said, therefore, that there is not enough clear evidence to recommend the routine use of acetylcysteine as prophylaxis for CIN (28,36,(38)(39) .…”

Prevention of contrast-associated acute kidney injury in cancer patients undergoing radiologic investigation using contrast media; a short-review to current knowledge

“…Accordingly, when acute kidney injury requiring dialysis, chemotherapeutic drug level may fluctuate and result in sub-therapeutic levels and potentially could lead to unsuccessful cancer treatment. In addition, simultaneous antibiotic administration or narcotics, may aggravate acute kidney injury of cancer patients (33)(34)(35).…”