Grant: Knowledge Synthesis Grant

<html> <body> <p>The guidelines on the prevention of contrast induced&nbsp;acute kidney injury(CI-AKI)&nbsp;recommend holding certain medications such as angiotensin converting enzyme inhibitors (ACE-i), angiotensin receptor blockers (ARB), non steroidal anti-inflammatory drugs (NSAIDS),&nbsp; diuretics and metformin prior to the exposure of contrast procedures. On one hand, current literature lacks a summarized evidence showing that it may be necessary to stop these drugs before radiocontrast procedures. On another hand, drug discontinuation prior to a medical intervention have been reported to constitute a risk that the therapy may not be always resumed following the intervention. Specifically, for NSAIDs, clinical outcomes such as acute myocardial infarction has been reported after discontinuation of aspirin while&nbsp;a rebound hypertension was reported after discontinuation of ACE-i. The overall research question of our project is formulated as follows: What is the evidence base behind the recommendation to hold medicines such as ACE-i/ARB, metformin, diuretics and NSAIDS before a contrast procedure? The goals of this systematic review will be to summarize available evidence on 1) the effect of withdrawal of ACE-Is/ARB, NSAIDS, diuretic or metformin before the administration of contrast media on the risk of CI-AKI and related renal complication [prolonged hospitalization, renal replacement therapy (RRT), lactic acidosis, death] in patients who undergo contrast procedures 2) the incidence of clinical adverse events such as cardiovascular events, rebound hypertension, hyperglycemia, weight gain or drugs not being restarted occurring during the period following the administration of contrast media among patients who withdrawal ACE-Is/ARB, NSAIDs, diuretics or metformin before receiving a contrast media.<br>The researchers involved in this project have an extensive experience in conducting systematic reviews. They include epidemiologists who will assist in selecting ,screening studies and analysing data, nephrologists, cardiologists and radiologists who will be involved in discussing findings and formulating recommendations.<br>To reach the goals, eight steps will be followed according to Cochrane methodology:1) formulating the question, 2) searching for eligible studies using a combination of Medical Subject Heading and relevant keywords contained in titles and abstracts within relevant bibliographic database, 3) selecting studies and collecting data by two authors who will independently screen titles and abstracts obtained from bibliographic databases, 4) assessment of methodological quality, 5) analysing and presenting results, 6) addressing reporting bias, 7) tabulate results and summary of findings 8) interpreting results and drawing conclusion. The End-of-grant knowledge translation plan will target guidelines developers, nephrologists, cardiologists,radiologists, pharmacists&nbsp;and patients. The&nbsp;strategies to be used for the diffusion and dissemination of&nbsp;review findings&nbsp;include publication in peer-reviewed journals,&nbsp;distribution of&nbsp;patients cards&nbsp;containing the keys findings of the review.&nbsp;We&nbsp;will organise a workshop&nbsp;whose purpose&nbsp;will be to discuss the application of reviews findings in clinical setting.<br>This systematic review will inform radiologists, nephrologists and cardiologists with the best available evidence about the effect of withholding ACEi or ARB or NSAIDs or&nbsp;diuretics or metformin before radiocontrast procedures on the risk of CI-AKI and related complications.</p> </body> </html>