Intensive Care Medicine

, Volume 43, Issue 6, pp 785–794 | Cite as

Contrast-associated acute kidney injury in the critically ill: systematic review and Bayesian meta-analysis

  • Stephan Ehrmann
  • Andrew Quartin
  • Brian P Hobbs
  • Vincent Robert-Edan
  • Cynthia Cely
  • Cynthia Bell
  • Genevieve Lyons
  • Tai Pham
  • Roland Schein
  • Yimin Geng
  • Karim Lakhal
  • Chaan S. Ng



Critically ill patients, among whom acute kidney injury is common, are often considered particularly vulnerable to iodinated contrast medium nephrotoxicity. However, the attributable incidence remains uncertain given the paucity of observational studies including a control group. This study assessed acute kidney injury incidence attributable to iodinated contrast media in critically ill patients based on new data accounting for sample and effect size and including a control group.


Systematic review of studies measuring incidence of acute kidney injury in critically ill patients following contrast medium exposure compared to matched unexposed patients. Patient-level meta-analysis implementing a Bayesian nested mixed effects multiple logistic regression model.


Ten studies were identified; only four took into account the baseline acute kidney injury risk, three by patient matching (560 patients). Objective meta-analysis of these three studies (vague and impartial a priori hypothesis concerning attributable acute kidney injury risk) did not find that iodinated contrast media increased the incidence of acute kidney injury (odds ratio 0.95, 95% highest posterior density interval 0.45–1.62). Bayesian analysis demonstrated that, to conclude in favor of a statistically significant incidence of acute kidney injury attributable to contrast media despite this observed lack of association, one’s a priori belief would have to be very strongly biased, assigning to previous uncontrolled reports 3–12 times the weight of evidence strength provided by the matched studies including a control group.


Meta-analysis of matched cohort studies of iodinated contrast medium exposure does not support a significant incidence of acute kidney injury attributable to iodinated contrast media in critically ill patients.


Contrast media (MeSH: D003287) Intensive care units (MeSH D007362) Drug-related side effects and adverse reactions (MeSH D064420) Tomography scanners, X-ray computed (MeSH: D015898) Percutaneous coronary interventions (MeSH: D062645) 



The authors acknowledge the following grant support: Cancer Center Support Grant and National Institute for health/National Cancer Institute grant P30CA016672.

Compliance with ethical standards

Conflicts of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Supplementary material

134_2017_4700_MOESM1_ESM.docx (379 kb)
Supplementary material 1 (DOCX 378 kb)


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Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2017

Authors and Affiliations

  • Stephan Ehrmann
    • 1
    • 2
  • Andrew Quartin
    • 3
    • 4
  • Brian P Hobbs
    • 5
  • Vincent Robert-Edan
    • 6
  • Cynthia Cely
    • 3
    • 4
  • Cynthia Bell
    • 7
  • Genevieve Lyons
    • 5
  • Tai Pham
    • 8
    • 9
    • 10
  • Roland Schein
    • 3
    • 4
  • Yimin Geng
    • 11
  • Karim Lakhal
    • 6
  • Chaan S. Ng
    • 12
  1. 1.Médecine Intensive RéanimationCentre Hospitalier Régional et Universitaire de ToursToursFrance
  2. 2.Faculté de MédecineUniversité François RabelaisToursFrance
  3. 3.Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of MedicineUniversity of Miami Miller School of MedicineMiamiUSA
  4. 4.Department of Veterans Affairs Medical CenterMiamiUSA
  5. 5.Department of BiostatisticsUniversity of Texas M.D. Anderson Cancer CenterHoustonUSA
  6. 6.Réanimation Chirurgicale PolyvalenteService d’Anesthésie-Réanimation, Hôpital Laënnec, Centre Hospitalier UniversitaireNantesFrance
  7. 7.Division of Pediatric Nephrology and HypertensionUniversity of Texas Health Science Center-HoustonHoustonUSA
  8. 8.Réanimation et USC Médico-chirurgicaleHôpital Tenon, Assistance Publique, Hôpitaux de ParisParisFrance
  9. 9.INSERM UMR 1153, ECSTRA TeamParisFrance
  10. 10.Saint Michael’s HospitalInterdepartmental Division of Critical Care, University of TorontoTorontoCanada
  11. 11.Research Medical LibraryUniversity of Texas M.D. Anderson Cancer CenterHoustonUSA
  12. 12.Department of RadiologyUniversity of Texas M.D. Anderson Cancer CenterHoustonUSA

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