title: Comparative Effectiveness of 12 Treatment Strategies for Preventing Contrast-Induced Acute Kidney Injury: A Systematic Review and Bayesian Network Meta-analysis.
abstract: BACKGROUND
  To simultaneously evaluate the relative efficacy of multiple pharmacologic strategies for preventing contrast-induced acute kidney injury (AKI).
  
  
  METHODS
  Systematic review containing a Bayesian network meta-analysis of randomized controlled trials.
  
  
  METHODS
  Participants undergoing diagnostic and/or interventional procedures with contrast media.
  
  
  METHODS
  Randomized controlled trials comparing the active drug treatments with each other or with hydration alone.
  
  
  METHODS
  Any of the following drugs in combination with hydration: N-acetylcysteine (NAC), theophylline (aminophylline), fenoldopam, iloprost, alprostadil, prostaglandin E1, statins, statins plus NAC, bicarbonate sodium, bicarbonate sodium plus NAC, ascorbic acid (vitamin C), tocopherol (vitamin E), α-lipoic acid, atrial natriuretic peptide, B-type natriuretic peptide, and carperitide.
  
  
  RESULTS
  The occurrence of contrast-induced AKI.
  
  
  RESULTS
  The trial network included 150 trials with 31,631 participants and 4,182 contrast-induced AKI events assessing 12 different interventions. Compared to hydration, ORs (95% credible intervals) for contrast-induced AKI were 0.31 (0.14-0.60) for high-dose statin plus NAC, 0.37 (0.19-0.64) for high-dose statin alone, 0.37 (0.17-0.72) for prostaglandins, 0.48 (0.26-0.82) for theophylline, 0.62 (0.40-0.88) for bicarbonate sodium plus NAC, 0.67 (0.54-0.81) for NAC alone, 0.64 (0.41-0.95) for vitamins and analogues, 0.70 (0.29-1.37) for natriuretic peptides, 0.69 (0.31-1.37) for fenoldopam, 0.78 (0.59-1.01) for bicarbonate sodium, and 0.98 (0.41-2.07) for low-dose statin. High-dose statin plus NAC or high-dose statin alone were likely to be ranked the best or the second best for preventing contrast-induced AKI. The overall results were not materially changed in metaregressions or subgroup and sensitivity analyses.
  
  
  CONCLUSIONS
  Patient-level data were unavailable; unable to include some treatment agents; low event rates; imbalanced distribution of participants among treatment strategies.
  
  
  CONCLUSIONS
  High-dose statins plus hydration with or without NAC might be the preferred treatment strategy to prevent contrast-induced AKI in patients undergoing diagnostic and/or interventional procedures requiring contrast media.
authors.affiliation: Renal Division, Peking University First Hospital; Peking University Institute of Nephrology; Key Laboratory of Renal Disease, Ministry of Health of China; Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, China; Renal Division, Shanxi Medical University Second Hospital, Shanxi Kidney Disease Institute, Taiyuan, China.
authors.forename: Xiaole
authors.initials: X
authors.lastname: Su
authors.affiliation: Renal Division, Peking University First Hospital; Peking University Institute of Nephrology; Key Laboratory of Renal Disease, Ministry of Health of China; Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, China.
authors.forename: Xinfang
authors.initials: X
authors.lastname: Xie
authors.affiliation: Renal Division, Peking University First Hospital; Peking University Institute of Nephrology; Key Laboratory of Renal Disease, Ministry of Health of China; Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, China. Electronic address: lijun.liu@medmail.com.cn.
authors.forename: Lijun
authors.initials: L
authors.lastname: Liu
authors.affiliation: Renal Division, Peking University First Hospital; Peking University Institute of Nephrology; Key Laboratory of Renal Disease, Ministry of Health of China; Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, China.
authors.forename: Jicheng
authors.initials: J
authors.lastname: Lv
authors.affiliation: Department of Population Health & Primary Care, Norwich Medical School, Faculty of Medicine and Health Science, University of East Anglia, Norwich, Norfolk, United Kingdom.
authors.forename: Fujian
authors.initials: F
authors.lastname: Song
authors.affiliation: The George Institute for Global Health, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Vlado
authors.initials: V
authors.lastname: Perkovic
authors.affiliation: Renal Division, Peking University First Hospital; Peking University Institute of Nephrology; Key Laboratory of Renal Disease, Ministry of Health of China; Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, China.
authors.forename: Hong
authors.initials: H
authors.lastname: Zhang
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000517:prevention & control*; D001499:Bayes Theorem; D003287:Contrast Media / Q000009:adverse effects*; D006801:Humans; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media
keywords: AKI prevention; Contrast-induced acute kidney injury (CI-AKI); N-acetylcysteine (NAC); acute kidney failure; atorvastatin; cardiovascular events; contrast media; hydroxymethylglutaryl-CoA reductase inhibitor; kidney disease; rosuvastatin; serum creatinine; simvastatin; statin; statins; systematic review