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Prevention of contrast-induced acute kidney injury in patients undergoing cardiovascular procedures-a systematic review and network meta-analysis.

Publication ,  Journal Article
Navarese, EP; Gurbel, PA; Andreotti, F; Kołodziejczak, MM; Palmer, SC; Dias, S; Buffon, A; Kubica, J; Kowalewski, M; Jadczyk, T; Laskiewicz, M ...
Published in: PLoS One
2017

BACKGROUND: Interventional diagnostic and therapeutic procedures requiring intravascular iodinated contrast steadily increase patient exposure to the risks of contrast-induced acute kidney injury (CIAKI), which is associated with death, nonfatal cardiovascular events, and prolonged hospitalization. The aim of this study was to investigate the efficacy of pharmacological and non-pharmacological treatments for CIAKI prevention in patients undergoing cardiovascular invasive procedures with iodinated contrast. METHODS AND FINDINGS: MEDLINE, Google Scholar, EMBASE and Cochrane databases as well as abstracts and presentations from major cardiovascular and nephrology meetings were searched, up to 22 April 2016. Eligible studies were randomized trials comparing strategies to prevent CIAKI (alone or in combination) when added to saline versus each other, saline, placebo, or no treatment in patients undergoing cardiovascular invasive procedures with administration of iodinated contrast. Two reviewers independently extracted trial-level data including number of patients, duration of follow-up, and outcomes. Eighteen strategies aimed at CIAKI prevention were identified. The primary outcome was the occurrence of CIAKI. Secondary outcomes were mortality, myocardial infarction, dialysis and heart failure. The data were pooled using network meta-analysis. Treatment estimates were calculated as odds ratios (ORs) with 95% credible intervals (CrI). 147 RCTs involving 33,463 patients were eligible. Saline plus N-acetylcysteine (OR 0.72, 95%CrI 0.57-0.88), ascorbic acid (0.59, 0.34-0.95), sodium bicarbonate plus N-acetylcysteine (0.59, 0.36-0.89), probucol (0.42, 0.15-0.91), methylxanthines (0.39, 0.20-0.66), statin (0.36, 0.21-0.59), device-guided matched hydration (0.35, 0.12-0.79), prostaglandins (0.26, 0.08-0.62) and trimetazidine (0.26, 0.09-0.59) were associated with lower odds of CIAKI compared to saline. Methylxanthines (0.12, 0.01-0.94) or left ventricular end-diastolic pressure-guided hydration (0.09, 0.01-0.59) were associated with lower mortality compared to saline. CONCLUSIONS: Currently recommended treatment with saline as the only measure to prevent CIAKI during cardiovascular procedures may not represent the optimal strategy. Vasodilators, when added to saline, may significantly reduce the odds of CIAKI following cardiovascular procedures.

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Published In

PLoS One

DOI

EISSN

1932-6203

Publication Date

2017

Volume

12

Issue

2

Start / End Page

e0168726

Location

United States

Related Subject Headings

  • Vasodilator Agents
  • Radiography, Interventional
  • Network Meta-Analysis
  • Kidney Function Tests
  • Humans
  • General Science & Technology
  • Diagnostic Techniques, Cardiovascular
  • Contrast Media
  • Acute Kidney Injury
 

Citation

APA
Chicago
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Navarese, E. P., Gurbel, P. A., Andreotti, F., Kołodziejczak, M. M., Palmer, S. C., Dias, S., … Strippoli, G. F. M. (2017). Prevention of contrast-induced acute kidney injury in patients undergoing cardiovascular procedures-a systematic review and network meta-analysis. PLoS One, 12(2), e0168726. https://doi.org/10.1371/journal.pone.0168726
Navarese, Eliano P., Paul A. Gurbel, Felicita Andreotti, Michalina Marta Kołodziejczak, Suetonia C. Palmer, Sofia Dias, Antonino Buffon, et al. “Prevention of contrast-induced acute kidney injury in patients undergoing cardiovascular procedures-a systematic review and network meta-analysis.PLoS One 12, no. 2 (2017): e0168726. https://doi.org/10.1371/journal.pone.0168726.
Navarese EP, Gurbel PA, Andreotti F, Kołodziejczak MM, Palmer SC, Dias S, et al. Prevention of contrast-induced acute kidney injury in patients undergoing cardiovascular procedures-a systematic review and network meta-analysis. PLoS One. 2017;12(2):e0168726.
Navarese, Eliano P., et al. “Prevention of contrast-induced acute kidney injury in patients undergoing cardiovascular procedures-a systematic review and network meta-analysis.PLoS One, vol. 12, no. 2, 2017, p. e0168726. Pubmed, doi:10.1371/journal.pone.0168726.
Navarese EP, Gurbel PA, Andreotti F, Kołodziejczak MM, Palmer SC, Dias S, Buffon A, Kubica J, Kowalewski M, Jadczyk T, Laskiewicz M, Jędrzejek M, Brockmeyer M, Airoldi F, Ruospo M, De Servi S, Wojakowski W, O’ Connor C, Strippoli GFM. Prevention of contrast-induced acute kidney injury in patients undergoing cardiovascular procedures-a systematic review and network meta-analysis. PLoS One. 2017;12(2):e0168726.

Published In

PLoS One

DOI

EISSN

1932-6203

Publication Date

2017

Volume

12

Issue

2

Start / End Page

e0168726

Location

United States

Related Subject Headings

  • Vasodilator Agents
  • Radiography, Interventional
  • Network Meta-Analysis
  • Kidney Function Tests
  • Humans
  • General Science & Technology
  • Diagnostic Techniques, Cardiovascular
  • Contrast Media
  • Acute Kidney Injury