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Hypertension as a Risk Factor for Contrast-Associated Acute Kidney Injury: A Meta-Analysis Including 2,830,338
Zhubin Lun1,2,3, Ziling Mai4, Liwei Liu1,5
1Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
Insights
Hypertension (HT) is an independent risk factor for contrast-associated acute kidney injury (CA-AKI). This meta-analysis confirms HT increases CA-AKI risk, aiding in patient risk stratification and prevention strategies.
Area of Science:
- Nephrology
- Cardiology
- Radiology
Background:
- The association between hypertension (HT) and contrast-associated acute kidney injury (CA-AKI) remains unclear.
- Previous studies have yielded inconclusive results regarding this relationship.
Purpose of the Study:
- To systematically review and meta-analyze existing studies.
- To assess the definitive association between hypertension and the risk of developing CA-AKI.
Main Methods:
- Searched Embase, Medline, and Cochrane databases up to March 25, 2021.
- Included 45 studies with 2,830,338 patients.
- Defined CA-AKI as a serum creatinine increase ≥25% or ≥0.5 mg/dL within 72 hours; pooled adjusted odds ratios using fixed or random models.
Main Results:
- Overall CA-AKI incidence was 6.48%.
- Hypertension was associated with an increased risk of CA-AKI (aOR: 1.378, 95% CI: 1.211-1.567).
- This association persisted across different CA-AKI definitions and timeframes.
Conclusions:
- Hypertension is confirmed as an independent risk factor for CA-AKI.
- Findings support using HT for CA-AKI risk stratification.
- Emphasizes increased clinical attention to HT management for CA-AKI prevention and treatment.
Objective:
Previous studies have shown that the relationship between hypertension (HT) and contrast-associated acute kidney injury (CA-AKI) is not clear. We apply a systematic review and meta-analysis to assess the association between HT and CA-AKI.
Methods:
We searched for articles on the study of risk factors for CA-AKI in the Embase, Medline, and Cochrane Database of Systematic Reviews (by March 25, 2021). Two authors independently performed quality assessment and extracted data such as the studies' clinical setting, the definition of CA-AKI, and the number of patients. The CA-AKI was defined as a serum creatinine (SCr) increase ≥25% or ≥0.5 mg/dL from baseline within 72 h. We used fixed or random models to pool adjusted OR (aOR) by STATA.
Results:
A total of 45 studies (2,830,338 patients) were identified, and the average incidence of CA-AKI was 6.48%. There was an increased risk of CA-AKI associated with HT (aOR: 1.378, 95% CI: 1.211-1.567, I2 = 67.9%). In CA-AKI with a SCr increase ≥50% or ≥0.3 mg/dL from baseline within 72 h, an increased risk of CA-AKI was associated with HT (aOR: 1.414, 95% CI: 1.152-1.736, I2 = 0%). In CA-AKI with a Scr increase ≥50% or ≥0.3 mg/dL from baseline within 7 days, HT increases the risk of CA-AKI (aOR: 1.317, 95% CI: 1.049-1.654, I2 = 51.5%).
Conclusion:
Our meta-analysis confirmed that HT is an independent risk factor for CA-AKI and can be used to identify risk stratification. Physicians should pay more attention toward prevention and treatment of patients with HT in clinical practice.
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