Abstract
BackgroundContrast-induced acute kidney injury is a common cause of iatrogenic acute kidney injury (AKI). Most of the published estimates of AKI after contrast use originate from the cardiac catheterization literature despite contrast-enhanced computed tomography (CT) scans being the more common setting for contrast use. This systematic review aims to summarize the current evidence about (1)the risk of AKI following intravenous (IV) contrast-enhanced CT scans and(2) the risk of clinical outcomes (i.e. death, hospitalization and need for renal replacement therapy) due to IV contrast-enhanced CT scans.Methods/DesignA systematic literature search for published studies will be performed using MEDLINE, EMBASE and The COCHRANE Library databases. Unpublished studies will be identified by searching through grey literature. No language restriction will be applied.The review will consider all studies that have examined the association between IV contrast media and AKI. To be selected, the study should include two arms: one group of exposed patients who received IV contrast material before CT scans and one group of unexposed group who did not receive contrast material before CT scans. Two authors will independently screen titles and abstracts obtained from electronic databases, extract data and will assess the quality of the studies selected using the Cochrane's ‘Risk of Bias’ assessment tool for randomized trials and the Newcastle-Ottawa Scale for observational studies. A random-effects meta-analysis will be performed if there is no remarkable heterogeneity between studies.DiscussionThis systematic review will provide synthesis of current evidence around the effect of IV contrast material on AKI and other clinical outcomes. Results will be helpful for making evidence-based recommendations and guidelines for clinical and radiologic settings.Systematic review registrationPROSPERO CRD42013003799.
Highlights
Contrast-induced acute kidney injury is a common cause of iatrogenic acute kidney injury (AKI)
Some studies suggest that the risk of AKI is lower after contrast-enhanced computed tomography (CT) scans compared to the risk following arterial cardiac catheterization [8,9]
These two reviews included a total of 13 studies (25,950 patients) conducted between 1985 and 2008 and comparing the incidence of AKI between a group of patients who received contrast material and a control group. They concluded no significant difference in the incidence of AKI between contrast patients and control group. This conclusion was confirmed by the meta-analysis performed in one of the two systematic reviews [15] showing a relative risk of developing an AKI after IV contrast material of 0.79 [95% confidence interval (CI) 0.62–1.02, P = 0.07] in patients who received intravenous contrast material compared to the control group
Summary
In recent years several meta-analyses addressed the question of nephropathy following intravascular contrast material [28,29,30,31]. The authors of this systematic review reported having modified the scale assessing the methodological quality They excluded the question assessing if the outcome of interest was not present at the start of the study, because the researchers did not determine whether patients had preexisting AKI in any studies included in the systematic review. These limitations could have affected the validity of the association between IV contrast and AKI.
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