Contrast-associated acute kidney injury in the critically ill: systematic review and Bayesian meta-analysis
- 1.8k Downloads
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.
KeywordsContrast 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.
- 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
- 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.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
- 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
- 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
- 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
- 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
- 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
- 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.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.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
- 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