Nonpharmacological Strategies to Prevent Contrast-Induced Acute Kidney Injury

Table 4

Characteristics of the studies included in the meta-analysis to evaluate the benefit of dialysis versus routine preventive care on the incidence of contrast-induced acute kidney injury.

Authors	Year published	Study design	Radiocontrast agent	Technique	Timing	Duration of extracorporeal treatment (hour)	Dialyzer	Blood flow; (mL/min)	Dialysate flow; (mL/min)	RR for CI-AKI; (95% CI)
Lehnert et al. [61]	1998	RCT	Iopentol	HD	63±6 min after radiocontrast procedure	3	Fresenius F50 (Fresenius Medical Care, Bad Homburg, Germany)	139±8	500	1.33 (95% CI 0.61–2.91)
Sterner et al. [62]	2000	RCT	Iohexol, Iodixanol, and Ioxaglate	HD	Maximum 3 hrs after radiocontrast procedure	4	Low-flux cellulose acetate or diacetate	200	500	1.70 (95% CI 0.59–4.90)
Vogt et al. [63]	2001	RCT	Nonionic low osmolarity	HD	Median 120 min (range 30–280) after radiocontrast procedure	3.1	Fresenius F50, F60 (Fresenius Medical Care)	180	500	1.27 (95% CI 0.80–2.01)
Berger et al. [64]	2001	RCT	Iopromide	HD	106±25 min after radiocontrast procedure	2-3	Fresenius F6 (Fresenius Medical Care)	220	500	3.43 (95% CI 0.45–25.93)
Frank et al. [65]	2003	RCT	Iomeprol	HD	Simultaneously with radiocontrast procedure	4	Fresenius F60 (Fresenius Medical Care)	200	500	Total clearance of contrast media was significantly increased and the area under curve (AUC) of contrast media concentration was significantly lower in the HD group when compared with control group. However, the authors did not report incidence of CI-AKI.
Gabutti et al. [48]	2003	Prospective cohort	Ioversol	CVVHDF	Simultaneously with radiocontrast procedure	10	Prisma M100 (Prisma, Hospal, Mirandola, Italy)	150	Replacement and dialysate 2,000 mL/h	1.56 (95% CI 0.66–3.72)
Marenzi et al. [49]	2003	RCT	Iopentol	CVVH	Initiated 4–6 hrs before, interrupted during, and resumed after radiocontrast procedure	22–30	Renaflow HF700 (Gambro, Mirandola, Italy)	100	Replacement 1,000 mL/hour; no dialysate	0.12 (95% CI 0.05–0.32)
Hsieh et al. [66]	2005	Retrospective cohort	Iopromide	HD	As soon as technically feasible	4	AM-Bio HX90 (Asahi Medical Co, Ltd, Tokyo, Japan)	200	500	0.33 (95% CI 0.01–7.72)
Marenzi et al. [67]	2006	RCT	Iopental	CVVH	6 hours before and for 18 to 24 hours after contrast exposure (pre-/posthemofiltration group) 18 to 24 hours after contrast exposure (posthemofiltration group)	18–30	Renaflow HF700 (Gambro, Mirandola, Italy)	100	Replacement 1,000 mL/hour; no dialysate	0.05 (95% CI 0.01–0.41) (pre-/posthemofiltration group) 0.52 (95% CI 0.17–1.56) (posthemofiltration group)
Lee et al. [52]	2007	RCT	Iohexol	HD	As soon as technically feasible (81±32 min, ranging from 45 to 180 min, after exposure to the contrast medium)	4	High-flux polysulfone membrane (BS1.8, Toray Industries, Inc., Tokyo, Japan).	150	500	0.07 (95% CI 0.01, 0.49)
Reinecke et al. [68]	2007	RCT	Iopromide	HD	Within 20 min after radiocontrast procedure	2	Fresenius 8, (Fresenius Medical Care)	180	500	Adjusted OR 2.2 (95% CI 0.9–5.7)

RCT: randomized controlled trial, HD: hemodialysis, CVVH: continuous venovenous hemofiltration, and CVVHDF: continuous venovenous hemodiafiltration.