What is the risk of acute kidney injury, renal replacement therapy, and mortality after computed tomography with intravenous contrast compared with computed tomography without use of contrast?

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Why is this study important?

Contrast induced nephropathy (CIN) or postcontrast acute kidney injury (PCAKI) is an ill-defined entity with little evidence supporting its clinical relevance. Multiple definitions have been published of which the most common in recent use appear to be the RIFLE (Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease) and the AKIN (Acute Kidney Injury Network) classifications.[1] These definitions have been combined by the Kidney Disease Improving Global Outcomes workgroup to establish a single classification of AKI. Regardless, due to multiple varying definitions, a true appreciation for the actual risk to patients undergoing contrast enhanced computed tomography (CT) is unknown. Also, whether the postcontrast rise in creatinine is coincidental (i.e., PCAKI) or caused by contrast exposure (i.e., CIN) is likely arguable in most cases. Confounding this is the multitude of patient associated factors (medications, diabetes, chronic renal insufficiency [CRI], etc.) that may underlie the true risk of clinically relevant CIN.  This study attempts to delineate the true risk for CIN utilizing a systematic review of the literature through 2016.

Which, if any, threats to validity are most likely to have an impact on the results and how?

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