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

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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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Acknowledgements

The authors acknowledge the following grant support: Cancer Center Support Grant and National Institute for health/National Cancer Institute grant P30CA016672.

Author information

Authors and Affiliations

  1. Médecine Intensive Réanimation, Centre Hospitalier Régional et Universitaire de Tours, 37044, Tours, France

    Stephan Ehrmann

  2. Faculté de Médecine, Université François Rabelais, Tours, France

    Stephan Ehrmann

  3. Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA

    Andrew Quartin, Cynthia Cely & Roland Schein

  4. Department of Veterans Affairs Medical Center, Miami, FL, USA

    Andrew Quartin, Cynthia Cely & Roland Schein

  5. Department of Biostatistics, University of Texas M.D. Anderson Cancer Center, Houston, TX, 77030, USA

    Brian P Hobbs & Genevieve Lyons

  6. Réanimation Chirurgicale Polyvalente, Service d’Anesthésie-Réanimation, Hôpital Laënnec, Centre Hospitalier Universitaire, Nantes, France

    Vincent Robert-Edan & Karim Lakhal

  7. Division of Pediatric Nephrology and Hypertension, University of Texas Health Science Center-Houston, Houston, TX, USA

    Cynthia Bell

  8. Réanimation et USC Médico-chirurgicale, Hôpital Tenon, Assistance Publique, Hôpitaux de Paris, 75970, Paris, France

    Tai Pham

  9. INSERM UMR 1153, ECSTRA Team, Paris, France

    Tai Pham

  10. Saint Michael’s Hospital, Interdepartmental Division of Critical Care, University of Toronto, Toronto, Canada

    Tai Pham

  11. Research Medical Library, University of Texas M.D. Anderson Cancer Center, Houston, TX, 77030, USA

    Yimin Geng

  12. Department of Radiology, University of Texas M.D. Anderson Cancer Center, Houston, TX, 77030, USA

    Chaan S. Ng

Authors
  1. Stephan Ehrmann
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  2. Andrew Quartin
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  3. Brian P Hobbs
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  4. Vincent Robert-Edan
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  5. Cynthia Cely
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  6. Cynthia Bell
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  7. Genevieve Lyons
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  8. Tai Pham
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  9. Roland Schein
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  10. Yimin Geng
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  11. Karim Lakhal
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  12. Chaan S. Ng
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Correspondence to Stephan Ehrmann.

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Additional information

Take-home message: This Bayesian meta-analysis of matched cohort studies of iodinated contrast medium exposure does not support a significant association with acute kidney injury incidence in critically ill patients. The continued belief that critically ill patients are particularly vulnerable to iodinated contrast medium nephrotoxicity rests on heavily weighting evidence from studies without a control group.

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Ehrmann, S., Quartin, A., Hobbs, B.P. et al. Contrast-associated acute kidney injury in the critically ill: systematic review and Bayesian meta-analysis. Intensive Care Med 43, 785–794 (2017). https://doi.org/10.1007/s00134-017-4700-9

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  • DOI: https://doi.org/10.1007/s00134-017-4700-9

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