Journal Club – Jan 2021

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

Outcome

  • 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
    • MortalityOR 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.

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