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
Original

Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusions

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.

Keywords

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) 

Notes

Acknowledgements

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)

References

  1. 1.
    Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group (2012) KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl 2:S1–S138. doi: 10.1038/kisup.2012.1 CrossRefGoogle Scholar
  2. 2.
    Brochard L, Abroug F, Brenner M, Broccard AF, Danner RL, Ferrer M, Laghi F, Magder S, Papazian L, Pelosi P, Polderman KH, ATS, ERS, ESICM, SCCM, SRLF Ad Hoc Committee on Acute Renal Failure (2010) An Official ATS/ERS/ESICM/SCCM/SRLF statement: prevention and management of acute renal failure in the ICU patient: an international consensus conference in intensive care medicine. Am J Respir Crit Care Med 181:1128–1155. doi: 10.1164/rccm.200711-1664ST CrossRefPubMedGoogle Scholar
  3. 3.
    Lautin EM, Freeman NJ, Schoenfeld AH, Bakal CW, Haramati N, Friedman AC, Lautin JL, Braha S, Kadish EG, Sprayregen S (1991) Radiocontrast-associated renal dysfunction: incidence and risk factors. AJR Am J Roentgenol 157:49–58. doi: 10.2214/ajr.157.1.2048539 CrossRefPubMedGoogle Scholar
  4. 4.
    Mehran R, Aymong ED, Nikolsky E, Lasic Z, Iakovou I, Fahy M, Mintz GS, Lansky AJ, Moses JW, Stone GW, Leon MB, Dangas G (2004) A simple risk score for prediction of contrast-induced nephropathy after percutaneous coronary intervention: development and initial validation. J Am Coll Cardiol 44:1393–1399. doi: 10.1016/j.jacc.2004.06.068 PubMedGoogle Scholar
  5. 5.
    Brown JR, DeVries JT, Piper WD, Robb JF, Hearne MJ, Ver Lee PM, Kellet MA, Watkins MW, Ryan TJ, Silver MT, Ross CS, MacKenzie TA, O’Connor GT, Malenka DJ, Northern New England Cardiovascular Disease Study Group (2008) Serious renal dysfunction after percutaneous coronary interventions can be predicted. Am Heart J 155:260–266. doi: 10.1016/j.ahj.2007.10.007 CrossRefPubMedGoogle Scholar
  6. 6.
    McDonald JS, McDonald RJ, Comin J, Williamson EE, Katzberg RW, Murad MH, Kallmes DF (2013) Frequency of acute kidney injury following intravenous contrast medium administration: a systematic review and meta-analysis. Radiology 267:119–128. doi: 10.1148/radiol.12121460 CrossRefPubMedGoogle Scholar
  7. 7.
    McDonald JS, McDonald RJ, Carter RE, Katzberg RW, Kallmes DF, Williamson EE (2014) Risk of intravenous contrast material-mediated acute kidney injury: a propensity score-matched study stratified by baseline-estimated glomerular filtration rate. Radiology 271:65–73. doi: 10.1148/radiol.13130775 CrossRefPubMedGoogle Scholar
  8. 8.
    McDonald RJ, McDonald JS, Carter RE, Hartman RP, Katzberg RW, Kallmes DF, Williamson EE (2014) Intravenous contrast material exposure is not an independent risk factor for dialysis or mortality. Radiology 273:714–725. doi: 10.1148/radiol.14132418 CrossRefPubMedGoogle Scholar
  9. 9.
    Rashid AH, Brieva JL, Stokes B (2009) Incidence of contrast-induced nephropathy in intensive care patients undergoing computerized tomography and prevalence of risk factors. Anaesth Intensive Care 37:968–975PubMedGoogle Scholar
  10. 10.
    Hoste EA, Doom S, De Waele J, Delrue LJ, Defreyne L, Benoit DD, Decruyenaere J (2011) Epidemiology of contrast-associated acute kidney injury in ICU patients: a retrospective cohort analysis. Intensive Care Med 37:1921–1931. doi: 10.1007/s00134-011-2389-8 CrossRefPubMedGoogle Scholar
  11. 11.
    Lakhal K, Ehrmann S, Chaari A, Laissy JP, Régnier B, Wolff M, Pajot O (2011) Acute Kidney Injury Network definition of contrast-induced nephropathy in the critically ill: incidence and outcome. J Crit Care 26:593–599. doi: 10.1016/j.jcrc.2011.05.010 CrossRefPubMedGoogle Scholar
  12. 12.
    Persson PB, Hansell P, Liss P (2005) Pathophysiology of contrast medium-induced nephropathy. Kidney Int 68:14–22. doi: 10.1038/sj.ki.5001887 CrossRefPubMedGoogle Scholar
  13. 13.
    Andreucci M, Solomon R, Tasanarong A (2014) Side effects of radiographic contrast media: pathogenesis, risk factors, and prevention. Biomed Res Int 214:741018. doi: 10.1155/2014/741018 Google Scholar
  14. 14.
    Fernandes SM, Martins DM, da Fonseca CD, Watanabe M, de Vattimo MF (2016) Impact of iodinated contrast on renal function and hemodynamics in rats with chronic hyperglycemia and chronic kidney disease. Biomed Res Int 2016:3019410. doi: 10.1155/2016/3019410 CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Rouse RL, Stewart SR, Thompson KL, Zhang J (2013) Kidney injury biomarkers in hypertensive, diabetic, and nephropathy rat models treated with contrast media. Toxicol Pathol 41:662–680. doi: 10.1177/0192623312464122 CrossRefPubMedGoogle Scholar
  16. 16.
    Heyman SN, Rosen S, Rosenberger C (2008) Renal parenchymal hypoxia, hypoxia adaptation, and the pathogenesis of radiocontrast nephropathy. Clin J Am Soc Nephrol 3:288–296. doi: 10.2215/CJN.02600607 CrossRefPubMedGoogle Scholar
  17. 17.
    Vandenberghe W, De Corte W, Hoste EA (2014) Contrast-associated AKI in the critically ill: relevant or irrelevant? Curr Opin Crit Care 20:596–605. doi: 10.1097/MCC.0000000000000156 CrossRefPubMedGoogle Scholar
  18. 18.
    Stewart LA, Clarke M, Rovers M, Riley RD, Simmonds M, Stewart G, Tierney JF, PRISMA-IPD Development Group (2015) Preferred reporting items for a systematic review and meta-analysis of individual participant data. The PRISMA-IPD statement. JAMA 313:1657–1665. doi: 10.1001/jama.2015.3656 CrossRefPubMedGoogle Scholar
  19. 19.
    Schardt C, Adams MB, Owens T, Keitz S, Fontelo P (2007) Utilization of the PICO framework to improve searching PubMed for clinical questions. BMC Med Inform Decis Mak 7:16. doi: 10.1186/1472-6947-7-16 CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Ruppert D, Wand MP, Carroll RJ (2003) Semiparametric regression. Cambridge University Press, New YorkCrossRefGoogle Scholar
  21. 21.
    Hobbs BP, Thall PF, Lin SH (2016) Bayesian Group sequential clinical trial design using total toxicity burden and progression-free survival. J R Stat Soc Ser C Appl Stat 65:273–297. doi: 10.1111/rssc.12117 CrossRefPubMedGoogle Scholar
  22. 22.
    Spiegelhalter DJ, Abrams KR, Myles JP (2003) Evidence synthesis. In: Spiegelhalter DJ, Abrams KR, Myles JP (eds) Bayesian approaches to clinical trials and health-care evaluation. Wiley, Chichester, pp 267–299CrossRefGoogle Scholar
  23. 23.
    Morita S, Thall PF, Müller P (2008) Determining the effective sample size of a parametric prior. Biometrics 64:595–602. doi: 10.1111/j.1541-0420.2007.00888.x CrossRefPubMedGoogle Scholar
  24. 24.
    Huber W, Jeschke B, Page M, Weiss W, Salmhofer H, Schweigart U, Ilgmann K, Reichenberger J, Neu B, Classen M (2001) Reduced incidence of radiocontrast-induced nephropathy in ICU patients under theophylline prophylaxis: a prospective comparison to series of patients at similar risk. Intensive Care Med 27:1200–1209CrossRefPubMedGoogle Scholar
  25. 25.
    Haveman JW, Gansevoort RT, Bongaerts AH, Nijsten MW (2006) Low incidence of nephropathy in surgical ICU patients receiving intravenous contrast: a retrospective analysis. Intensive Care Med 32:1199–1205. doi: 10.1007/s00134-006-0198-2 CrossRefPubMedGoogle Scholar
  26. 26.
    Polena S, Yang S, Alam R, Gricius J, Gupta JR, Badalova N, Chuang P, Gintautas J, Conetta R (2005) Nephropathy in critically ill patients without preexisting renal disease. Proc West Pharmacol Soc 48:134–135PubMedGoogle Scholar
  27. 27.
    Tremblay LN, Tien H, Hamilton P, Brenneman FD, Rizoli SB, Sharkey PW, Chu P, Rozycki GS (2005) Risk and benefit of intravenous contrast in trauma patients with an elevated serum creatinine. J Trauma 59:1162–1166CrossRefPubMedGoogle Scholar
  28. 28.
    Oleinik A, Romero JM, Schwab K, Lev MH, Jhawar N, Delgado Almandoz JE, Smith EE, Greenberg SM, Rosand J, Goldstein JN (2009) CT angiography for intracerebral hemorrhage does not increase risk of acute nephropathy. Stroke 40:2393–2397. doi: 10.1161/STROKEAHA.108.546127 CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    McGillicuddy EA, Schuster KM, Kaplan LJ, Maung AA, Lui FY, Maerz LL, Johnson DC, Davis KA (2010) Contrast-induced nephropathy in elderly trauma patients. J Trauma 68:294–297. doi: 10.1097/TA.0b013e3181cf7e40 CrossRefPubMedGoogle Scholar
  30. 30.
    Ng CS, Shaw AD, Bell CS, Samuels JA (2010) Effect of IV contrast medium on renal function in oncologic patients undergoing CT in ICU. AJR Am J Roentgenol 195:414–422. doi: 10.2214/AJR.09.4150 CrossRefPubMedGoogle Scholar
  31. 31.
    Cely CM, Schein RM, Quartin AA (2012) Risk of contrast induced nephropathy in the critically ill: a prospective, case matched study. Crit Care 16:R67. doi: 10.1186/cc11317 CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Kim DY, Kobayashi L, Costantini TW, Chang D, Fortlage D, Curry T, Wynn S, Doucet J, Bansal V, Coimbra R (2012) Is contrast exposure safe among the highest risk trauma patients? J Trauma Acute Care Surg 72:61–66. doi: 10.1097/TA.0b013e31823f36e0 CrossRefPubMedGoogle Scholar
  33. 33.
    Ehrmann S, Badin J, Savath L, Pajot O, Garot D, Pham T, Capdevila X, Perrotin D, Lakhal K (2013) Acute kidney injury in the critically ill: is iodinated contrast medium really harmful? Crit Care Med 41:1017–1026. doi: 10.1097/CCM.0b013e318275871a CrossRefPubMedGoogle Scholar
  34. 34.
    Christ M, Auenmüller KI, Amirie S, Brand M, Sasko BM, Trappe HJ (2016) Acute kidney injury and renal replacement therapy in victims from out-of-hospital cardiac arrest with administration of contrast agent. Herzschrittmarcherther Elektrophysiol 27:6–14. doi: 10.1007/s00399-015-0410-6 CrossRefGoogle Scholar
  35. 35.
    Gao J, Zhang M, Fang G, Ye L, Tang W (2005) Risk and harm of contrast induced nephropathy in critically ill patients. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue 27:366–370. doi: 10.3760/cma.j.issn.2095-4352.2015.05.009 Google Scholar
  36. 36.
    Wilhelm-Leen E, Montez-Rath ME, Chertow G (2016) Estimating the risk of radiocontrast-associated nephropathy. J Am Soc Nephrol 28. doi: 10.1681/ASN.2016010021
  37. 37.
    Subramaniam RM, Suarez-Cuervo C, Wilson RF, Turban S, Zhang A, Sherrod C, Aboagye J, Eng J, Choi MJ, Hutfless S, Bass EB (2016) Effectiveness of prevention strategies for contrast-induced nephropathy: a systematic review and meta-analysis. Ann Intern Med 164:406–416. doi: 10.7326/M15-1456 CrossRefPubMedGoogle Scholar
  38. 38.
    Eng J, Wilson RF, Subramaniam RM, Zhang A, Suarez-Cuervo C, Turban S, Choi MJ, Sherrod C, Hutfless S, Lyoha EE, Bass EB (2016) Comparative effect of contrast media type on the incidence of contrast-induced nephropathy: a systematic review and meta-analysis. Ann Intern Med 164:417–424. doi: 10.7326/M15-1402 CrossRefPubMedGoogle Scholar
  39. 39.
    Salmon-Gandonnière C, Benz-de-Bretagne I, Mercier E, Joret A, Halimi JM, Ehrmann S, Barin-Le Guellec C (2016) Iohexol clearance in unstable critically ill patients: a tool to assess glomerular filtration rate. Clin Chem Lab Med 54:1777–1786. doi: 10.1515/cclm-2015-1202 CrossRefPubMedGoogle Scholar
  40. 40.
    Bihorac A, Chawla LS, Shaw AD, Al-Khafaji A, Davison DL, Demuth GE, Gitzgerald R, Gong MN, Graham DD, Gunnerson K, Heung M, Jortani S, Kleerup E, Koyner JL, Krell K, Letourneau J, Lissauer M, Miner J, Nguyen HB, Ortega LM, Self WH, Sellman R, Shi J, Straseski J, Szalados JE, Wilber ST, Walker MG, Wilson J, Wunderink R, Zimmerman J, Kellum JA (2014) Validation of cell-cycle arrest biomarkers for acute kidney injury using clinical adjudication. Am J Respir Crit Care Med 189:932–999. doi: 10.1164/rccm.201401-0077OC CrossRefPubMedGoogle Scholar

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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