Prophylactic Interventions for Contrast-Induced Nephropathy: A Systematic Review and Meta-Analysis

INTRODUCTION

Current randomized control trials (RCTs) have reported conflicting findings for determining which prophylactic intervention is most effective for contrast-induced nephropathy (CIN). Iodinated contrast media, which play a key role in angiographic procedures, are associated with a decline in kidney function when administered to patients intravenously. Unfortunately, the decline in kidney function has been associated with an increase in mortality, morbidity and healthcare costs. The 3 most common prophylactic interventions for CIN include the volume expanders, normal saline (NS), and sodium bicarbonate (NaHCO₃); and N- acetylcysteine, which has antioxidant and vasodilatory effects.

RESEARCH QUESTION

We aimed to conduct a pooled analysis comparing renal outcomes between these three regimens used for CIN prophylaxis.

STUDY DESIGN

Systematic review and meta-analysis of RCTs.

METHODS

An electronic literature search was conducted in PubMed and Embase, without regard to language, to identify RCTs that included patients who received IV NS, IV NaHCO3, and/or IV or oral N-acetylcysteine prior to undergoing an angiographic procedure with contrast media. Primary outcomes included the development of CI-AKI, as defined by each RCT. Title/abstract and full-text screening, along with data collection was completed in duplicate using Covidence. An I² test will be used to assess for heterogeneity with a threshold of 25% to be meaningful. The Cochrane’s Q test will be used to assess significance at an alpha level of 0.1. Additionally, if it is appropriate to pool the trials, a random-effect meta-analysis will be used to estimate the pooled odds of experiencing CIN associated with each intervention compared to placebo and compared to each other. For each outcome, we will visually examine funnel plots, and conduct Egger’s tests to assess for publication bias and/or other small study effects.

RESULTS

We included 92 studies after title/abstract and full-text screening screening. Final results will be presented at completion of study.

CONCLUSIONS

Research in-progress

References

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