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

Is CA-AKI preventable in ICU patients?


  • Woraphon Choatwongwachira Department of Medicine, Chiang Mai University, Chiang Mai, Thailand, 50200
  • Sidaporn Louisirirotchanakul Department of Surgery, Chiang Mai University, Chiang Mai, Thailand, 50200
  • Kaweesak Chittawatanarat Department of Surgery, Chiang Mai University, Chiang Mai,Thailand, 50200
  • Chidchanok Ruengorn Pharmacoepidemiology and Statistics Research Center (PESRC), Chiang Mai University, Chiang Mai, Thailand, 50200
  • Konlawij Trongtrakul Department of Medicine, Chiang Mai University, Chiang Mai, Thailand, 50200
  • Srisuluk Kacha Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand, 50200



Critically-ill, Contrast-associated acute kidney injury, Network meta-analysis


Introduction: Limited information exists on preventing contrast-associated acute kidney injury (CA-AKI) in critically-ill patients. Extrapolating preventive strategies from non-critically-ill to critically-ill patients may jeopardize data validity. Therefore, it is imperative to evaluate the efficacy of preventive strategies by consolidating available clinical trial evidence through this systematic review and network meta-analysis (NMA).

Methods and Analysis: We will conduct a comprehensive search of electronic databases, including PubMed, Embase, and Scopus, from their inception dates, with no language limitations. We will include both randomized trials and non-randomized studies that employ validated measurement tools to investigate the benefits of pharmacological interventions in patients undergoing contrast-enhanced computed tomography (CECT). The primary outcome of interest is the incidence of CA-AKI in medically and surgically critically-ill patients who receive medication prior to undergoing CECT. A pair of reviewers will independently perform risk of bias assessments and evaluate the strength of the evidence. We will employ a two-step approach, consisting of traditional pairwise meta-analysis and NMA. Utilizing a random-effects model, we will pool effect estimates as standardized weighted mean differences and odds ratios (ORs) with corresponding 95% confidence intervals (CIs) for continuous and categorical endpoints, respectively. We will assess both statistical and methodological heterogeneities. Preplanned subgroup analyses and univariate meta-regression will be conducted to quantify potential sources of heterogeneity. Evidence synthesis will be based on the effect size magnitudes, certainty of evidence, and surface under the cumulative ranking curve values.


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How to Cite

Choatwongwachira W, Louisirirotchanakul S, Chittawatanarat K, Ruengorn C, Trongtrakul K, Kacha S. Prevention of contrast-associated acute kidney injury in critically-ill and high-risk preoperative patient: Protocol for a systematic review and network meta-analysis: Is CA-AKI preventable in ICU patients?. Clin Crit Care [Internet]. 2023 Mar. 29 [cited 2024 Jun. 14];31(1):2023:e0005. Available from:



Research Protocol