A Bayesian network meta-analysis of preventive strategies for contrast-induced nephropathy after cardiac...

Area of Science:

• Cardiology
• Nephrology
• Pharmacology

Background:

• Contrast induced acute kidney injury (CIAKI) is a significant risk following cardiac catheterization.
• Optimal preventive strategies for CIAKI remain uncertain, necessitating comparative effectiveness research.

Purpose of the Study:

• To conduct a Bayesian network meta-analysis (NMA) comparing various preventive strategies for CIAKI.
• To identify the most effective intervention for CIAKI prevention in patients undergoing cardiac catheterization.

Main Methods:

• A systematic literature search of MEDLINE, EMBASE, and CENTRAL databases was performed for randomized controlled trials up to December 1, 2017.
• Bayesian network meta-analysis was employed to compare 28,063 patients across multiple intervention groups, including normal saline, sodium bicarbonate, statins, N-acetylcysteine, and placebo.
• Odds ratios (OR) with 95% credible intervals (CrI) and surface under the cumulative ranking curve (SUCRA) were calculated to assess treatment efficacy and ranking.

Main Results:

• Statins demonstrated a significant reduction in CIAKI risk compared to normal saline (OR: 0.50; 95% CrI, 0.25-0.99) and placebo (OR: 0.44; 95% CrI, 0.24-0.83).
• In subgroup analyses of patients receiving low osmolar contrast, statins reduced CIAKI risk by 58% versus normal saline and 51% versus placebo.
• No significant differences were observed in the risk of hemodialysis or all-cause mortality across treatments; statins ranked highest for reducing CIAKI, hemodialysis, and mortality risk (SUCRA scores 0.86, 0.88, and 0.81, respectively).

Conclusions:

• Statins represent a superior preventive strategy for CIAKI compared to normal saline and placebo.
• The findings support the use of statins as an effective measure to mitigate CIAKI risk in cardiac catheterization procedures.