Contour Plot Assessment of Existing Meta-Analyses Confirms Robust Association of Statin Use and Acute Kidney Injury Risk

J Clin Epidemiol. 2015 Oct;68(10):1138-43. doi: 10.1016/j.jclinepi.2015.05.030. Epub 2015 Jun 16.


Objectives: Robustness of an existing meta-analysis can justify decisions on whether to conduct an additional study addressing the same research question. We illustrate the graphical assessment of the potential impact of an additional study on an existing meta-analysis using published data on statin use and the risk of acute kidney injury.

Study design and setting: A previously proposed graphical augmentation approach is used to assess the sensitivity of the current test and heterogeneity statistics extracted from existing meta-analysis data. In addition, we extended the graphical augmentation approach to assess potential changes in the pooled effect estimate after updating a current meta-analysis and applied the three graphical contour definitions to data from meta-analyses on statin use and acute kidney injury risk.

Results: In the considered example data, the pooled effect estimates and heterogeneity indices demonstrated to be considerably robust to the addition of a future study. Supportingly, for some previously inconclusive meta-analyses, a study update might yield statistically significant kidney injury risk increase associated with higher statin exposure.

Conclusions: The illustrated contour approach should become a standard tool for the assessment of the robustness of meta-analyses. It can guide decisions on whether to conduct additional studies addressing a relevant research question.

Keywords: Contour plot; Evidence-based medicine; Funnel plot; Kidney injury; Meta-analysis; Sensitivity analysis; Statins.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Kidney Injury / chemically induced*
  • Acute Kidney Injury / epidemiology
  • Data Interpretation, Statistical
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / administration & dosage
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / adverse effects*
  • Meta-Analysis as Topic*
  • Models, Statistical
  • Propensity Score
  • Research Design
  • Risk Factors


  • Hydroxymethylglutaryl-CoA Reductase Inhibitors