Abstract
Aims Many previous studies have examined the effect of different hydration strategies on prevention of contrast-induced acute kidney injury (CI-AKI), but the optimal strategy is unknown. We performed a network meta-analysis (NWM) of these previous studies to identify the optimal strategy. Methods and Results Web of Science, PubMed, OVID Medline, and Cochrane Library were searched from their inception dates to September 30, 2018. Randomized controlled trials (RCTs) were selected based on strict inclusion criteria, and a Bayesian NWM was performed using WinBUGS V.1.4.3. We finally analyzed 60 eligible RCTs, which examined 21,293 patients and 2232 CI-AKI events. Compared to intravenous 0.9% sodium chloride (reference), intravenous sodium bicarbonate (OR [95% CI]: 0.74 [0.57, 0.93]), hemodynamic guided hydration (0.41 [0.18, 0.93]), and RenalGuard guided hydration (0.32 [0.14, 0.70]) significantly reduced the occurrence of CI-AKI. Oral hydration and intravenous 0.9% sodium chloride were each noninferior to no hydration in preventing CI-AKI. Intravenous 0.9% sodium chloride, sodium bicarbonate, and hemodynamic guided hydration were each noninferior to oral hydration in preventing CI-AKI. Based on surface under the cumulative ranking curve values, the RenalGuard system was best (0.974) and hemodynamic guided hydration was second best (0.849). Conclusion There was substantial evidence to support the use of RenalGuard or hemodynamic guided hydration for preventing CI-AKI in high-risk patients, especially those with chronic kidney disease or cardiac dysfunction.
Highlights
Contrast-induced acute kidney injury (CI-AKI), referred to as contrast-induced nephropathy (CIN), is an iatrogenic complication that can occur following intravascular administration of iodinated contrast medium (CM) prior to radiography
We initially identified 3620 publications, assessed 703 randomized controlled trials (RCTs) for eligibility by review of the full texts, and included 60 RCTs which met the eligibility criteria (Figure 1). ese studies examined 21,293 patients and 2232 confidence interval (CI)-AKI events
Twenty-three studies provided the values of left ventricular ejection fraction (LVEF); the mean LVEF ranged from 25% to 57.8% (49.0 [42.8, 54.5]). e percentage of diabetes mellitus (DM) patients ranged from 8% to 100%, and the percentage with heart failure (HF) ranged from 0.6% to 45.8%
Summary
Contrast-induced acute kidney injury (CI-AKI), referred to as contrast-induced nephropathy (CIN), is an iatrogenic complication that can occur following intravascular administration of iodinated contrast medium (CM) prior to radiography. Weisbord et al [11] enrolled 5177 high-risk patients and reported no benefit of intravenous sodium bicarbonate relative to normal saline Another RCT [12] concluded that the benefit of sodium bicarbonate was marginal relative to isotonic sodium chloride for preventing CI-AKI among critically ill patients. Other studies indicated that the RenalGuard System [13,14,15,16] and hemodynamic guided hydration [17,18,19] were safe and effective in preventing CI-AKI Because of these apparently discrepant results, we conducted a network meta-analysis (NMA) to assess the effects of various hydration strategies on the occurrence of CI-AKI in an effort to identify the optimal strategy for prevention of CI-AKI
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