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01-06-2017 | Original

Contrast-associated acute kidney injury in the critically ill: systematic review and Bayesian meta-analysis

Authors: Stephan Ehrmann, Andrew Quartin, Brian P Hobbs, Vincent Robert-Edan, Cynthia Cely, Cynthia Bell, Genevieve Lyons, Tai Pham, Roland Schein, Yimin Geng, Karim Lakhal, Chaan S. Ng

Published in: Intensive Care Medicine | Issue 6/2017

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.

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Title: Contrast-associated acute kidney injury in the critically ill: systematic review and Bayesian meta-analysis
Authors: Stephan Ehrmann
Andrew Quartin
Brian P Hobbs
Vincent Robert-Edan
Cynthia Cely
Cynthia Bell
Genevieve Lyons
Tai Pham
Roland Schein
Yimin Geng
Karim Lakhal
Chaan S. Ng
Publication date: 01-06-2017
Publisher: Springer Berlin Heidelberg
Published in: Intensive Care Medicine / Issue 6/2017
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-017-4700-9

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Contrast-associated acute kidney injury in the critically ill: systematic review and Bayesian meta-analysis

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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