Prevention of contrast-associated acute kidney injury in critically-ill and high-risk preoperative patient: Protocol for a systematic review and network meta-analysis

Introduction: There is limited information of the contrast-associated acute kidney (CA-AKI) prevention in critically-ill patients. Applying the evidence for CA-AKI prevention from non-critically-ill to critically-ill patients could potentially invalidate the data. Therefore, we find it necessary to assess the benefits of preventive strategy by summarizing existing evidence from clinical trials in this systematic review and network meta‐analysis (NMA). Methods and analysis: We will search electronic databases, including PubMed, Embase, and Scopus from their inception dates with no language restrictions. Both randomized trials and non-randomized studies using validated measurement tools that investigated the benefits of pharmacological interventions among patients who undergo contrast enhanced computed tomography (CECT). The primary outcome is the incidence of CA-AKI in medical and surgical critically-ill patients who undergo CECT after receiving medication. The risk of bias assessment and analysis of the strength of the evidence will be performed independently by a pair of reviewers. A two-step approach of traditional pairwise and NMA will be performed. Based on a random-effects model, standardized weighted mean differences and ORs with corresponding 95% CIs will be pooled as effect estimates for the continuous and categorical endpoints, respectively. Statistical and methodological heterogeneities will be assessed. Preplanned subgroup analyses and univariate meta-regression will be conducted to quantify the potential sources of heterogeneity. Evidence-based synthesis will be based on the magnitudes of effect size, evidence certainty and the surface under the cumulative ranking curve values.   Ethics: Ethical approval is not required because this study is based on existing published data.  PROSPERO registration number: CRD42022328974