Renal Replacement Therapy for Prevention of Contrast- induced Acute Kidney Injury: A Meta-analysis of Randomized Controlled Trials Source Song K, Jiang.

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Renal Replacement Therapy for Prevention of Contrast- induced Acute Kidney Injury: A Meta-analysis of Randomized Controlled Trials Source Song K, Jiang S, Shi Y, et al. Renal replacement therapy for prevention of contrast-induced acute kidney injury: a meta-analysis of randomized controlled trials. Am J Nephrol. 2010;32(5):497–504.

Background One of the commonest cause for acute kidney injury is contrast-induced acute kidney injury (CI-AKI) accounting for 5–50% of cases of hospital- acquired acute kidney injury. Although contrast can be effectively eliminated by hemodialysis and hemofiltration, it is still controversial whether renal replacement therapy (RRT) is able to reduce the incidence of CI-AKI. Several randomized controlled trials (RCTs) have been conducted; however, the results have been conflicting.

Aim To obtain current estimate on the effect of RRT for prevention of CI-AKI.

Methods

Key results RRT reduced the risk of CI-AKI by 26% compared to control, but statistical significance was not reached (risk ratio (RR): 0.74, 95% CI: 0.35–1.60, p=0.45). Subgroup analysis of modality indicated that hemodialysis was ineffective in reducing the risk of CI-AKI (RR: 1.21, 95% CI: 0.63–2.32, p=0.57), while CRRT decreased the incidence of CI-AKI (RR: 0.22, 95% CI: 0.07–0.64, p=0.006) (Fig. 1). Subgroup analysis according to the CKD stage did not record heterogeneity across trials. RRT increased the odds of CI-AKI in CKD stage 3 patients (RR: 1.53, 95% CI: 0.07–0.64, p=0.01), but decreased the occurrence of CI-AKI in patients with CKD stage higher than 3 (RR: 0.74, 95% CI: 0.35–1.60, p=0.45) (Fig. 1). The pooled RR of the need for permanent dialysis demonstrated an insignificant trend towards benefit in patients treated with RRT (RR: 0.61, 95% CI: 0.26–1.40, p=0.24). RRT reduced in-hospital mortality compared with control group (RR: 0.33, 95% CI: 0.14–0.77, p=0.01).

Conclusion This study suggests that RRT does not reduce the incidence of CI-AKI in CKD stage 3 patients, but may be beneficial and effective in reducing in-hospital mortality in patients with more advanced renal function. Continuous renal replacement therapy is more effective than hemodialysis for prevention of CI-AKI.