Prevention of contrast-induced acute kidney injury in patients undergoing cardiovascular procedures-A systematic review and network meta-Analysis

Eliano P. Navarese, Paul A. Gurbel, Felicita Andreotti, Michalina Marta Koøodziejczak, Suetonia C. Palmer, Sofia Dias, Antonino Buffon, Jacek Kubica, Mariusz Kowalewski, Tomasz Jadczyk, Michaø Laskiewicz, Marek Jȩdrzejek, Maximillian Brockmeyer, Flavio Airoldi, Marinella Ruospo, Stefano De Servi, Wojciech Wojakowski, Christopher O'Connor, Giovanni F M Strippoli

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Article numbere0168726
JournalPLoS One
Volume12
Issue number2
DOIs
StatePublished - Feb 1 2017
Externally publishedYes

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Acetylcysteine
systematic review
Acute Kidney Injury
meta-analysis
Hydration
Trimetazidine
kidneys
Probucol
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Sodium Bicarbonate
Dialysis
Vasodilator Agents
Ascorbic Acid
Prostaglandins
acetylcysteine
odds ratio
probucol
Heart Failure
Odds Ratio
Therapeutics

ASJC Scopus subject areas

  • Medicine(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

Cite this

Navarese, E. P., Gurbel, P. A., Andreotti, F., Koøodziejczak, 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

Prevention of contrast-induced acute kidney injury in patients undergoing cardiovascular procedures-A systematic review and network meta-Analysis. / Navarese, Eliano P.; Gurbel, Paul A.; Andreotti, Felicita; Koøodziejczak, Michalina Marta; Palmer, Suetonia C.; Dias, Sofia; Buffon, Antonino; Kubica, Jacek; Kowalewski, Mariusz; Jadczyk, Tomasz; Laskiewicz, Michaø; Jȩdrzejek, Marek; Brockmeyer, Maximillian; Airoldi, Flavio; Ruospo, Marinella; Servi, Stefano De; Wojakowski, Wojciech; O'Connor, Christopher; Strippoli, Giovanni F M.

In: PLoS One, Vol. 12, No. 2, e0168726, 01.02.2017.

Research output: Contribution to journalArticle

Navarese, EP, Gurbel, PA, Andreotti, F, Koøodziejczak, MM, Palmer, SC, Dias, S, Buffon, A, Kubica, J, Kowalewski, M, Jadczyk, T, Laskiewicz, M, Jȩdrzejek, M, Brockmeyer, M, Airoldi, F, Ruospo, M, Servi, SD, Wojakowski, W, O'Connor, C & Strippoli, GFM 2017, '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, e0168726. https://doi.org/10.1371/journal.pone.0168726
Navarese, Eliano P. ; Gurbel, Paul A. ; Andreotti, Felicita ; Koøodziejczak, Michalina Marta ; Palmer, Suetonia C. ; Dias, Sofia ; Buffon, Antonino ; Kubica, Jacek ; Kowalewski, Mariusz ; Jadczyk, Tomasz ; Laskiewicz, Michaø ; Jȩdrzejek, Marek ; Brockmeyer, Maximillian ; Airoldi, Flavio ; Ruospo, Marinella ; Servi, Stefano De ; Wojakowski, Wojciech ; O'Connor, Christopher ; Strippoli, Giovanni F M. / Prevention of contrast-induced acute kidney injury in patients undergoing cardiovascular procedures-A systematic review and network meta-Analysis. In: PLoS One. 2017 ; Vol. 12, No. 2.
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abstract = "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.",
author = "Navarese, {Eliano P.} and Gurbel, {Paul A.} and Felicita Andreotti and Ko{\o}odziejczak, {Michalina Marta} and Palmer, {Suetonia C.} and Sofia Dias and Antonino Buffon and Jacek Kubica and Mariusz Kowalewski and Tomasz Jadczyk and Micha{\o} Laskiewicz and Marek Jȩdrzejek and Maximillian Brockmeyer and Flavio Airoldi and Marinella Ruospo and Servi, {Stefano De} and Wojciech Wojakowski and Christopher O'Connor and Strippoli, {Giovanni F M}",
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T1 - Prevention of contrast-induced acute kidney injury in patients undergoing cardiovascular procedures-A systematic review and network meta-Analysis

AU - Navarese, Eliano P.

AU - Gurbel, Paul A.

AU - Andreotti, Felicita

AU - Koøodziejczak, Michalina Marta

AU - Palmer, Suetonia C.

AU - Dias, Sofia

AU - Buffon, Antonino

AU - Kubica, Jacek

AU - Kowalewski, Mariusz

AU - Jadczyk, Tomasz

AU - Laskiewicz, Michaø

AU - Jȩdrzejek, Marek

AU - Brockmeyer, Maximillian

AU - Airoldi, Flavio

AU - Ruospo, Marinella

AU - Servi, Stefano De

AU - Wojakowski, Wojciech

AU - O'Connor, Christopher

AU - Strippoli, Giovanni F M

PY - 2017/2/1

Y1 - 2017/2/1

N2 - 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.

AB - 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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