A Bayesian network meta-analysis of preventive strategies for contrast-induced nephropathy after cardiac catheterization.
Acetylcysteine
/ therapeutic use
Acute Kidney Injury
/ chemically induced
Aged
Bayes Theorem
Cardiac Catheterization
/ adverse effects
Contrast Media
/ administration & dosage
Female
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors
/ therapeutic use
Male
Middle Aged
Network Meta-Analysis
Protective Factors
Randomized Controlled Trials as Topic
Renal Dialysis
Risk Assessment
Risk Factors
Sodium Bicarbonate
/ therapeutic use
Cardiac catheterization
Contrast induced acute renal insufficiency
Contrast induced nephropathy
Statins
Journal
Cardiovascular revascularization medicine : including molecular interventions
ISSN: 1878-0938
Titre abrégé: Cardiovasc Revasc Med
Pays: United States
ID NLM: 101238551
Informations de publication
Date de publication:
01 2019
01 2019
Historique:
received:
09
04
2018
revised:
06
06
2018
accepted:
07
06
2018
entrez:
14
2
2019
pubmed:
14
2
2019
medline:
12
2
2020
Statut:
ppublish
Résumé
The optimal preventive strategy for contrast induced acute kidney injury (CIAKI) in patients undergoing cardiac catheterization remains uncertain. We conducted Bayesian network meta-analysis (NMA) to compare different preventive strategies for CIAKI in these cohorts. Forty-nine randomized controlled trials were extracted using MEDLINE, EMBASE and CENTRAL data bases (inception-1st December 2017). We calculated median of the odds ratio (OR) with the corresponding 95% credible interval (CrI). The ranking probability of each treatment was based on SUCRA (surface under the cumulative ranking curve). In NMA of 28,063 patients [normal saline (NS: 9716 patients), sodium bicarbonate (NaHCO3: 4484 patients), statin (2542 patients), N-acetylcysteine (NAC: 3006 patients), NAC + NaHCO3 (774 patients), NS + NAC (3807 patients), NS + NaHCO3 (135 patients) and placebo (3599 patients)], statins reduced the relative risk of CIAKI compared with NS (OR: 0.50; 95% CrI, 0.25-0.99), and placebo (OR: 0.44; 95% CrI, 0.24-0.83). Subgroup analyses showed that in patients receiving low osmolar contrast, statins reduced the relative risk of CIAKI by 58% versus NS, and 51% versus placebo. There were no significant differences across all the treatments in terms of risk of hemodialysis or all-cause mortality. Statins had the highest probability for reducing the risk of CIAKI (SUCRA, 0.86), risk of hemodialysis (SUCRA, 0.88) and all-cause mortality (SUCRA, 0.81). Statins were the superior preventive strategy for reducing the risk of CIAKI compared with NS alone and placebo.
Sections du résumé
BACKGROUND
The optimal preventive strategy for contrast induced acute kidney injury (CIAKI) in patients undergoing cardiac catheterization remains uncertain.
OBJECTIVE
We conducted Bayesian network meta-analysis (NMA) to compare different preventive strategies for CIAKI in these cohorts.
METHODS
Forty-nine randomized controlled trials were extracted using MEDLINE, EMBASE and CENTRAL data bases (inception-1st December 2017). We calculated median of the odds ratio (OR) with the corresponding 95% credible interval (CrI). The ranking probability of each treatment was based on SUCRA (surface under the cumulative ranking curve).
RESULTS
In NMA of 28,063 patients [normal saline (NS: 9716 patients), sodium bicarbonate (NaHCO3: 4484 patients), statin (2542 patients), N-acetylcysteine (NAC: 3006 patients), NAC + NaHCO3 (774 patients), NS + NAC (3807 patients), NS + NaHCO3 (135 patients) and placebo (3599 patients)], statins reduced the relative risk of CIAKI compared with NS (OR: 0.50; 95% CrI, 0.25-0.99), and placebo (OR: 0.44; 95% CrI, 0.24-0.83). Subgroup analyses showed that in patients receiving low osmolar contrast, statins reduced the relative risk of CIAKI by 58% versus NS, and 51% versus placebo. There were no significant differences across all the treatments in terms of risk of hemodialysis or all-cause mortality. Statins had the highest probability for reducing the risk of CIAKI (SUCRA, 0.86), risk of hemodialysis (SUCRA, 0.88) and all-cause mortality (SUCRA, 0.81).
CONCLUSION
Statins were the superior preventive strategy for reducing the risk of CIAKI compared with NS alone and placebo.
Identifiants
pubmed: 30757995
pii: S1553-8389(18)30249-5
doi: 10.1016/j.carrev.2018.06.005
pii:
doi:
Substances chimiques
Contrast Media
0
Hydroxymethylglutaryl-CoA Reductase Inhibitors
0
Sodium Bicarbonate
8MDF5V39QO
Acetylcysteine
WYQ7N0BPYC
Types de publication
Journal Article
Meta-Analysis
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
29-37Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2018 Elsevier Inc. All rights reserved.