Extracorporeal Blood Purification Therapies for Prevention of Radiocontrast-Induced Nephropathy: A Systematic Review

Dinna N. Cruz, Mark A. Perazella, Rinaldo Bellomo, Valentina Corradi, Massimo de Cal, Dingwei Kuang, Catalina Ocampo, Federico Nalesso, Claudio Ronco

Research output: Contribution to journalReview ArticleResearchpeer-review

78 Citations (Scopus)

Abstract

Background: Radiocontrast-induced nephropathy (RCIN) causes acute kidney injury and increases mortality. Studies have examined the capacity of various forms of extracorporeal blood purification therapies for the prevention of RCIN, with conflicting results. We conducted a systematic review of published trials to determine whether periprocedural extracorporeal blood purification prevents RCIN. Methods: We searched PubMed, the Cochrane Collaboration Database, EMBASE, and CINAHL through January 2006 and bibliographies of retrieved articles and consulted with experts to identify relevant studies. Published studies of extracorporeal blood purification for the prevention of RCIN in patients receiving radiocontrast were included. Two authors reviewed all citations. The primary end point is the incidence of RCIN, defined as an increase in serum creatinine concentration (≥0.5 mg/dL [≥44 μmol/L]). Results were combined on the risk ratio scale. Random-effects models were used. Sensitivity analyses were performed to evaluate the effects of extracorporeal blood purification modality, study design, and sample size. Results: Eight trials (6 randomized controlled trials, 2 nonrandomized trials) were included in the analysis (pooled sample size, 412). Six trials assessed hemodialysis, whereas 1 trial each assessed continuous venovenous hemofiltration and continuous venovenous hemodiafiltration. The incidence of RCIN was 35.2% in the standard-medical-therapy group and 27.8% in the extracorporeal-blood-purification group. Extracorporeal blood purification did not decrease the incidence of RCIN significantly compared with standard medical therapy (risk ratio, 0.97; 95% confidence interval, 0.44 to 2.14); however, intertrial heterogeneity was high. Limiting analysis to only randomized trials did not eliminate heterogeneity, but limiting analysis to only hemodialysis trials did. Periprocedural hemodialysis did not decrease the incidence of RCIN. Conclusion: This critical analysis of the published literature suggests that periprocedural extracorporeal blood purification does not decrease the incidence of RCIN compared with standard medical therapy.

Original languageEnglish
Pages (from-to)361-371
Number of pages11
JournalAmerican Journal of Kidney Diseases
Volume48
Issue number3
DOIs
Publication statusPublished - 1 Sep 2006
Externally publishedYes

Keywords

  • Continuous renal replacement therapy
  • hemodialysis (HD)
  • hemofiltration
  • meta-analysis
  • prevention
  • radiocontrast nephropathy

Cite this

Cruz, Dinna N. ; Perazella, Mark A. ; Bellomo, Rinaldo ; Corradi, Valentina ; de Cal, Massimo ; Kuang, Dingwei ; Ocampo, Catalina ; Nalesso, Federico ; Ronco, Claudio. / Extracorporeal Blood Purification Therapies for Prevention of Radiocontrast-Induced Nephropathy : A Systematic Review. In: American Journal of Kidney Diseases. 2006 ; Vol. 48, No. 3. pp. 361-371.
@article{93b7a876837f482787f0696ba50c733a,
title = "Extracorporeal Blood Purification Therapies for Prevention of Radiocontrast-Induced Nephropathy: A Systematic Review",
abstract = "Background: Radiocontrast-induced nephropathy (RCIN) causes acute kidney injury and increases mortality. Studies have examined the capacity of various forms of extracorporeal blood purification therapies for the prevention of RCIN, with conflicting results. We conducted a systematic review of published trials to determine whether periprocedural extracorporeal blood purification prevents RCIN. Methods: We searched PubMed, the Cochrane Collaboration Database, EMBASE, and CINAHL through January 2006 and bibliographies of retrieved articles and consulted with experts to identify relevant studies. Published studies of extracorporeal blood purification for the prevention of RCIN in patients receiving radiocontrast were included. Two authors reviewed all citations. The primary end point is the incidence of RCIN, defined as an increase in serum creatinine concentration (≥0.5 mg/dL [≥44 μmol/L]). Results were combined on the risk ratio scale. Random-effects models were used. Sensitivity analyses were performed to evaluate the effects of extracorporeal blood purification modality, study design, and sample size. Results: Eight trials (6 randomized controlled trials, 2 nonrandomized trials) were included in the analysis (pooled sample size, 412). Six trials assessed hemodialysis, whereas 1 trial each assessed continuous venovenous hemofiltration and continuous venovenous hemodiafiltration. The incidence of RCIN was 35.2{\%} in the standard-medical-therapy group and 27.8{\%} in the extracorporeal-blood-purification group. Extracorporeal blood purification did not decrease the incidence of RCIN significantly compared with standard medical therapy (risk ratio, 0.97; 95{\%} confidence interval, 0.44 to 2.14); however, intertrial heterogeneity was high. Limiting analysis to only randomized trials did not eliminate heterogeneity, but limiting analysis to only hemodialysis trials did. Periprocedural hemodialysis did not decrease the incidence of RCIN. Conclusion: This critical analysis of the published literature suggests that periprocedural extracorporeal blood purification does not decrease the incidence of RCIN compared with standard medical therapy.",
keywords = "Continuous renal replacement therapy, hemodialysis (HD), hemofiltration, meta-analysis, prevention, radiocontrast nephropathy",
author = "Cruz, {Dinna N.} and Perazella, {Mark A.} and Rinaldo Bellomo and Valentina Corradi and {de Cal}, Massimo and Dingwei Kuang and Catalina Ocampo and Federico Nalesso and Claudio Ronco",
year = "2006",
month = "9",
day = "1",
doi = "10.1053/j.ajkd.2006.05.023",
language = "English",
volume = "48",
pages = "361--371",
journal = "American Journal of Kidney Diseases",
issn = "0272-6386",
publisher = "Elsevier",
number = "3",

}

Extracorporeal Blood Purification Therapies for Prevention of Radiocontrast-Induced Nephropathy : A Systematic Review. / Cruz, Dinna N.; Perazella, Mark A.; Bellomo, Rinaldo; Corradi, Valentina; de Cal, Massimo; Kuang, Dingwei; Ocampo, Catalina; Nalesso, Federico; Ronco, Claudio.

In: American Journal of Kidney Diseases, Vol. 48, No. 3, 01.09.2006, p. 361-371.

Research output: Contribution to journalReview ArticleResearchpeer-review

TY - JOUR

T1 - Extracorporeal Blood Purification Therapies for Prevention of Radiocontrast-Induced Nephropathy

T2 - A Systematic Review

AU - Cruz, Dinna N.

AU - Perazella, Mark A.

AU - Bellomo, Rinaldo

AU - Corradi, Valentina

AU - de Cal, Massimo

AU - Kuang, Dingwei

AU - Ocampo, Catalina

AU - Nalesso, Federico

AU - Ronco, Claudio

PY - 2006/9/1

Y1 - 2006/9/1

N2 - Background: Radiocontrast-induced nephropathy (RCIN) causes acute kidney injury and increases mortality. Studies have examined the capacity of various forms of extracorporeal blood purification therapies for the prevention of RCIN, with conflicting results. We conducted a systematic review of published trials to determine whether periprocedural extracorporeal blood purification prevents RCIN. Methods: We searched PubMed, the Cochrane Collaboration Database, EMBASE, and CINAHL through January 2006 and bibliographies of retrieved articles and consulted with experts to identify relevant studies. Published studies of extracorporeal blood purification for the prevention of RCIN in patients receiving radiocontrast were included. Two authors reviewed all citations. The primary end point is the incidence of RCIN, defined as an increase in serum creatinine concentration (≥0.5 mg/dL [≥44 μmol/L]). Results were combined on the risk ratio scale. Random-effects models were used. Sensitivity analyses were performed to evaluate the effects of extracorporeal blood purification modality, study design, and sample size. Results: Eight trials (6 randomized controlled trials, 2 nonrandomized trials) were included in the analysis (pooled sample size, 412). Six trials assessed hemodialysis, whereas 1 trial each assessed continuous venovenous hemofiltration and continuous venovenous hemodiafiltration. The incidence of RCIN was 35.2% in the standard-medical-therapy group and 27.8% in the extracorporeal-blood-purification group. Extracorporeal blood purification did not decrease the incidence of RCIN significantly compared with standard medical therapy (risk ratio, 0.97; 95% confidence interval, 0.44 to 2.14); however, intertrial heterogeneity was high. Limiting analysis to only randomized trials did not eliminate heterogeneity, but limiting analysis to only hemodialysis trials did. Periprocedural hemodialysis did not decrease the incidence of RCIN. Conclusion: This critical analysis of the published literature suggests that periprocedural extracorporeal blood purification does not decrease the incidence of RCIN compared with standard medical therapy.

AB - Background: Radiocontrast-induced nephropathy (RCIN) causes acute kidney injury and increases mortality. Studies have examined the capacity of various forms of extracorporeal blood purification therapies for the prevention of RCIN, with conflicting results. We conducted a systematic review of published trials to determine whether periprocedural extracorporeal blood purification prevents RCIN. Methods: We searched PubMed, the Cochrane Collaboration Database, EMBASE, and CINAHL through January 2006 and bibliographies of retrieved articles and consulted with experts to identify relevant studies. Published studies of extracorporeal blood purification for the prevention of RCIN in patients receiving radiocontrast were included. Two authors reviewed all citations. The primary end point is the incidence of RCIN, defined as an increase in serum creatinine concentration (≥0.5 mg/dL [≥44 μmol/L]). Results were combined on the risk ratio scale. Random-effects models were used. Sensitivity analyses were performed to evaluate the effects of extracorporeal blood purification modality, study design, and sample size. Results: Eight trials (6 randomized controlled trials, 2 nonrandomized trials) were included in the analysis (pooled sample size, 412). Six trials assessed hemodialysis, whereas 1 trial each assessed continuous venovenous hemofiltration and continuous venovenous hemodiafiltration. The incidence of RCIN was 35.2% in the standard-medical-therapy group and 27.8% in the extracorporeal-blood-purification group. Extracorporeal blood purification did not decrease the incidence of RCIN significantly compared with standard medical therapy (risk ratio, 0.97; 95% confidence interval, 0.44 to 2.14); however, intertrial heterogeneity was high. Limiting analysis to only randomized trials did not eliminate heterogeneity, but limiting analysis to only hemodialysis trials did. Periprocedural hemodialysis did not decrease the incidence of RCIN. Conclusion: This critical analysis of the published literature suggests that periprocedural extracorporeal blood purification does not decrease the incidence of RCIN compared with standard medical therapy.

KW - Continuous renal replacement therapy

KW - hemodialysis (HD)

KW - hemofiltration

KW - meta-analysis

KW - prevention

KW - radiocontrast nephropathy

UR - http://www.scopus.com/inward/record.url?scp=33747595435&partnerID=8YFLogxK

U2 - 10.1053/j.ajkd.2006.05.023

DO - 10.1053/j.ajkd.2006.05.023

M3 - Review Article

C2 - 16931209

AN - SCOPUS:33747595435

VL - 48

SP - 361

EP - 371

JO - American Journal of Kidney Diseases

JF - American Journal of Kidney Diseases

SN - 0272-6386

IS - 3

ER -