Renal Replacement Therapy for Prevention of Contrast-Induced Acute Kidney Injury: A Meta-Analysis of Randomized Controlled Trials

Abstract

Background: Contrast-induced acute kidney injury (CI-AKI) is an important cause of acute renal injury. Several clinical trials using renal replacement therapy (RRT) for prevention of CI-AKI yielded conflicting results. We performed a meta-analysis to assess the efficacy of prophylactic RRT on CI-AKI. Methods: Randomized controlled trials on CI-AKI using RRT were identified without language restriction in Cochrane library, Pubmed and Embase. Data extracted from literature were analyzed with Review manager and Stata software. Results: Nine randomized controlled trials involving 751 patients were included. Heterogeneity was found across trials (p < 0.00001). A random effect model was used to combine the data. RRT reduced the risk of CI-AKI by 26% compared with the control group, but statistical significance was not reached (risk ratio (RR) 0.74, 95% CI 0.35–1.60, p = 0.45). Subgroup analysis of modality indicated that hemodialysis was ineffective in reducing the risk of CI-AKI (RR 1.21, 95% CI 0.63–2.32, p = 0.57), while CRRT decreased the incidence of CI-AKI (RR 0.22, 95% CI 0.07–0.64, p = 0.006). Subgroup analysis according to the CKD stage did not record heterogeneity across trials. RRT increased the odds of CI-AKI in CKD stage 3 patients (RR 1.53, 95% CI 0.07–0.64, p = 0.01), but decreased the occurrence of CI-AKI in patients with CKD stage higher than 3 (RR 0.74, 95% CI 0.35–1.60, p = 0.45). The pooled RR of the need for permanent dialysis demonstrated an insignificant trend towards benefit in patients treated with RRT (RR 0.61, 95% CI 0.26–1.40, p = 0.24). RRT reduced in-hospital mortality compared with control group (RR 0.33, 95% CI 0.14–0.77, p = 0.01). Conclusion: RRT fails to reduce the incidence of CI-AKI in CKD stage 3 patients, but may be beneficial in patients with more advanced renal function. CRRT is more effective than hemodialysis for prevention of CI-AKI. RRT is effective in reducing the in-hospital mortality of CI-AKI patients.

Guidelines on the use of iodinated contrast media in patients with kidney disease 2012: digest version

“…It has been reported that 60-90 % of the contrast medium is removed during 1 session of hemodialysis. Clinical studies have been conducted on the basis of these findings to investigate the efficacy of hemodialysis, hemodiafiltration, and hemofiltration in the prevention of CIN [160][161][162][163][164][165][166][167][168][169]. However, most studies could not demonstrate the efficacy of these procedures in the prevention of CIN.…”

Preventing radiocontrast-induced nephropathy in chronic kidney disease patients undergoing coronary angiography

“…In an effort to reconcile the disparate clinical trial findings, systematic reviews and meta-analyses have been performed to analyze the collective results of relevant studies [80,81] . Cruz et al [80] conducted a meta-analysis of blood purification therapies for the prevention of RCIN.…”

“…In sensitivity analyses that included only those studies of hemodialysis, inter-trial heterogeneity was not statistically significant, yet there was a trend toward greater risk for RCIN with hemodialysis compared with standard preventive care [80] . In a recently published meta-analysis, Song et al [81] compared the different modes of RRT in assessing the efficacy of prophylactic RRT on RCIN in 751 patients. They found considerable heterogeneity across trials (P < 0.00001).…”

Corrigendum Regarding the Article by Song et al. Entitled ‘Renal Replacement Therapy for Prevention of Contrast-Induced Acute Kidney Injury: A Meta-Analysis of Randomized Controlled Trials’

“…We read with interest the meta-analysis by Song et al [1] on renal replacement therapy (RRT) for the prevention of contrast-induced acute kidney injury (CI-AKI). In principle we agree that whatever benefit prophylactic RRT may offer, this is likely limited to a high-risk population with a high pretest probability of CI-AKI, including those with severe chronic kidney disease (CKD).…”

“…Furthermore, in figure 3 of Song et al [1] , they indicate the number of patients who develop CI-AKI for each study.…”