Stephan Ehrmann1,2, Andrew Quartin3,4, Brian P Hobbs5, Vincent Robert-Edan6, Cynthia Cely3,4, Cynthia Bell7, Genevieve Lyons5, Tai Pham8,9,10, Roland Schein3,4, Yimin Geng11, Karim Lakhal6, Chaan S Ng12. 1. Médecine Intensive Réanimation, Centre Hospitalier Régional et Universitaire de Tours, 37044, Tours, France. stephanehrmann@gmail.com. 2. Faculté de Médecine, Université François Rabelais, Tours, France. stephanehrmann@gmail.com. 3. Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA. 4. Department of Veterans Affairs Medical Center, Miami, FL, USA. 5. Department of Biostatistics, University of Texas M.D. Anderson Cancer Center, Houston, TX, 77030, USA. 6. Réanimation Chirurgicale Polyvalente, Service d'Anesthésie-Réanimation, Hôpital Laënnec, Centre Hospitalier Universitaire, Nantes, France. 7. Division of Pediatric Nephrology and Hypertension, University of Texas Health Science Center-Houston, Houston, TX, USA. 8. Réanimation et USC Médico-chirurgicale, Hôpital Tenon, Assistance Publique, Hôpitaux de Paris, 75970, Paris, France. 9. INSERM UMR 1153, ECSTRA Team, Paris, France. 10. Saint Michael's Hospital, Interdepartmental Division of Critical Care, University of Toronto, Toronto, Canada. 11. Research Medical Library, University of Texas M.D. Anderson Cancer Center, Houston, TX, 77030, USA. 12. Department of Radiology, University of Texas M.D. Anderson Cancer Center, Houston, TX, 77030, USA.
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.
PURPOSE:Critically illpatients, 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 illpatients 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 illpatients 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 illpatients.
Entities:
Keywords:
Contrast media (MeSH: D003287); Drug-related side effects and adverse reactions (MeSH D064420); Intensive care units (MeSH D007362); Percutaneous coronary interventions (MeSH: D062645); Tomography scanners, X-ray computed (MeSH: D015898)
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