Prevention of contrast-induced acute kidney injury in patients undergoing cardiovascular procedures-a systematic review and network meta-analysis.
<h4>Background</h4>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 prolonge...
Saved in:
| Main Authors: | , , , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Public Library of Science (PLoS)
2017-01-01
|
| Series: | PLoS ONE |
| Online Access: | https://doi.org/10.1371/journal.pone.0168726 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1839627748605165568 |
|---|---|
| author | Eliano P Navarese Paul A Gurbel Felicita Andreotti Michalina Marta Kołodziejczak Suetonia C Palmer Sofia Dias Antonino Buffon Jacek Kubica Mariusz Kowalewski Tomasz Jadczyk Michał Laskiewicz Marek Jędrzejek Maximillian Brockmeyer Flavio Airoldi Marinella Ruospo Stefano De Servi Wojciech Wojakowski Christopher O' Connor Giovanni F M Strippoli |
| author_facet | Eliano P Navarese Paul A Gurbel Felicita Andreotti Michalina Marta Kołodziejczak Suetonia C Palmer Sofia Dias Antonino Buffon Jacek Kubica Mariusz Kowalewski Tomasz Jadczyk Michał Laskiewicz Marek Jędrzejek Maximillian Brockmeyer Flavio Airoldi Marinella Ruospo Stefano De Servi Wojciech Wojakowski Christopher O' Connor Giovanni F M Strippoli |
| author_sort | Eliano P Navarese |
| collection | DOAJ |
| description | <h4>Background</h4>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.<h4>Methods and findings</h4>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.<h4>Conclusions</h4>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. |
| format | Article |
| id | doaj-art-c47f29f0919e4d0d8d8b46ad0ad674dc |
| institution | Matheson Library |
| issn | 1932-6203 |
| language | English |
| publishDate | 2017-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj-art-c47f29f0919e4d0d8d8b46ad0ad674dc2025-07-16T05:31:30ZengPublic Library of Science (PLoS)PLoS ONE1932-62032017-01-01122e016872610.1371/journal.pone.0168726Prevention of contrast-induced acute kidney injury in patients undergoing cardiovascular procedures-a systematic review and network meta-analysis.Eliano P NavaresePaul A GurbelFelicita AndreottiMichalina Marta KołodziejczakSuetonia C PalmerSofia DiasAntonino BuffonJacek KubicaMariusz KowalewskiTomasz JadczykMichał LaskiewiczMarek JędrzejekMaximillian BrockmeyerFlavio AiroldiMarinella RuospoStefano De ServiWojciech WojakowskiChristopher O' ConnorGiovanni F M Strippoli<h4>Background</h4>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.<h4>Methods and findings</h4>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.<h4>Conclusions</h4>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.https://doi.org/10.1371/journal.pone.0168726 |
| spellingShingle | Eliano P Navarese Paul A Gurbel Felicita Andreotti Michalina Marta Kołodziejczak Suetonia C Palmer Sofia Dias Antonino Buffon Jacek Kubica Mariusz Kowalewski Tomasz Jadczyk Michał Laskiewicz Marek Jędrzejek Maximillian Brockmeyer Flavio Airoldi Marinella Ruospo Stefano De Servi Wojciech Wojakowski Christopher O' Connor Giovanni F M Strippoli Prevention of contrast-induced acute kidney injury in patients undergoing cardiovascular procedures-a systematic review and network meta-analysis. PLoS ONE |
| title | Prevention of contrast-induced acute kidney injury in patients undergoing cardiovascular procedures-a systematic review and network meta-analysis. |
| title_full | Prevention of contrast-induced acute kidney injury in patients undergoing cardiovascular procedures-a systematic review and network meta-analysis. |
| title_fullStr | Prevention of contrast-induced acute kidney injury in patients undergoing cardiovascular procedures-a systematic review and network meta-analysis. |
| title_full_unstemmed | Prevention of contrast-induced acute kidney injury in patients undergoing cardiovascular procedures-a systematic review and network meta-analysis. |
| title_short | Prevention of contrast-induced acute kidney injury in patients undergoing cardiovascular procedures-a systematic review and network meta-analysis. |
| title_sort | prevention of contrast induced acute kidney injury in patients undergoing cardiovascular procedures a systematic review and network meta analysis |
| url | https://doi.org/10.1371/journal.pone.0168726 |
| work_keys_str_mv | AT elianopnavarese preventionofcontrastinducedacutekidneyinjuryinpatientsundergoingcardiovascularproceduresasystematicreviewandnetworkmetaanalysis AT paulagurbel preventionofcontrastinducedacutekidneyinjuryinpatientsundergoingcardiovascularproceduresasystematicreviewandnetworkmetaanalysis AT felicitaandreotti preventionofcontrastinducedacutekidneyinjuryinpatientsundergoingcardiovascularproceduresasystematicreviewandnetworkmetaanalysis AT michalinamartakołodziejczak preventionofcontrastinducedacutekidneyinjuryinpatientsundergoingcardiovascularproceduresasystematicreviewandnetworkmetaanalysis AT suetoniacpalmer preventionofcontrastinducedacutekidneyinjuryinpatientsundergoingcardiovascularproceduresasystematicreviewandnetworkmetaanalysis AT sofiadias preventionofcontrastinducedacutekidneyinjuryinpatientsundergoingcardiovascularproceduresasystematicreviewandnetworkmetaanalysis AT antoninobuffon preventionofcontrastinducedacutekidneyinjuryinpatientsundergoingcardiovascularproceduresasystematicreviewandnetworkmetaanalysis AT jacekkubica preventionofcontrastinducedacutekidneyinjuryinpatientsundergoingcardiovascularproceduresasystematicreviewandnetworkmetaanalysis AT mariuszkowalewski preventionofcontrastinducedacutekidneyinjuryinpatientsundergoingcardiovascularproceduresasystematicreviewandnetworkmetaanalysis AT tomaszjadczyk preventionofcontrastinducedacutekidneyinjuryinpatientsundergoingcardiovascularproceduresasystematicreviewandnetworkmetaanalysis AT michałlaskiewicz preventionofcontrastinducedacutekidneyinjuryinpatientsundergoingcardiovascularproceduresasystematicreviewandnetworkmetaanalysis AT marekjedrzejek preventionofcontrastinducedacutekidneyinjuryinpatientsundergoingcardiovascularproceduresasystematicreviewandnetworkmetaanalysis AT maximillianbrockmeyer preventionofcontrastinducedacutekidneyinjuryinpatientsundergoingcardiovascularproceduresasystematicreviewandnetworkmetaanalysis AT flavioairoldi preventionofcontrastinducedacutekidneyinjuryinpatientsundergoingcardiovascularproceduresasystematicreviewandnetworkmetaanalysis AT marinellaruospo preventionofcontrastinducedacutekidneyinjuryinpatientsundergoingcardiovascularproceduresasystematicreviewandnetworkmetaanalysis AT stefanodeservi preventionofcontrastinducedacutekidneyinjuryinpatientsundergoingcardiovascularproceduresasystematicreviewandnetworkmetaanalysis AT wojciechwojakowski preventionofcontrastinducedacutekidneyinjuryinpatientsundergoingcardiovascularproceduresasystematicreviewandnetworkmetaanalysis AT christopheroconnor preventionofcontrastinducedacutekidneyinjuryinpatientsundergoingcardiovascularproceduresasystematicreviewandnetworkmetaanalysis AT giovannifmstrippoli preventionofcontrastinducedacutekidneyinjuryinpatientsundergoingcardiovascularproceduresasystematicreviewandnetworkmetaanalysis |