Acute Kidney Injury After Computed Tomography: A Meta-analysis

Wed 27th Jan 12-13:00 – OUTCOME

TEAMS meeting

Everyone is welcome – Nursing and medical, no experience necessary
Read the article – check your emails
- (we have emailed out to you – if not, email darren or huw and we will send a copy)
Your opinion – Whats good and bad about the study, would this change your practice?
Come along – We will discuss; how to read a paper, what everyone thinks about the paper
if you can’t make it – feel free to post your thoughts below so we can bring them up

Well conducted meta-analysis
Current evidence base – mainly retrospect observational studies So…
- Many potential unknown biases at play for those receiving contrast vs not
  - Less sick – mortality falsely reduced
  - Sicker – mortality falsely increased
  - Better pre-test renal function – falsely reduces AKI and need for replacement therapy
Results shows that use of contrast, does not sigificantly affect
- Development of AKI (various definitions) – OR 0.938 95% CI 0.825-1.065
- Mortality – OR 0.998 95% CI 0.73-1.36
- Need for “Renal replacement therapy” (non-defined) – OR 0.825 95%CI 0.587-1.160 (however looks like its tending to significance)
Bottom Line
- Evidence
  - Ideally do an RCT – to show what affect contrast really has (but not likely)
  - Several other Meta-analysis published including by radiologist – all “Failed” to show contrast caused AKI
- Clinical – its a clinical judgment!
  - If contrast will answer a clinically important question – Give it its unlikely to cause an AKI, and may expedite care
  - If contrast not clinically needed – with holding contrast doesn’t seem to increase mortality.