Contrast induced-acute kidney injury following peripheral angiography with carbon dioxide versus iodinated contrast media: A meta-analysis and systematic review of current literature

Saad S. Ghumman, Jonathan Weinerman, Aazib Khan, Mubeen S. Cheema, Marlene Garcia, Daniel Levin, Rajeev Suri, Anand Prasad

Research output: Contribution to journalArticle

5 Scopus citations


Objective: We conducted a meta-analysis to compare the incidence of acute kidney injury (AKI) with carbon dioxide (CO2) versus iodinated contrast media (ICM). Background: Contrast induced-acute kidney injury (CI-AKI) is a known complication following endovascular procedures with ICM. CO2 has been employed as an alternative imaging medium as it is nontoxic to the kidneys. Methods: Search of indexed databases was performed and 1,732 references were retrieved. Eight studies (7 observational, 1 Randomized Controlled Trial) formed the meta-analysis. Primary outcome was AKI. Fixed effect model was used when possible in addition to analysis of publication bias. Results: In this meta-analysis, 677 patients underwent 754 peripheral angiographic procedures. Compared with ICM, CO2 was associated with a decreased incidence of AKI (4.3% vs. 11.1%; OR 0.465, 95% CI: 0.218-0.992; P=0.048). Subgroup analysis of four studies that included granular data for patients with chronic kidney disease (CKD) did not demonstrate a decreased incidence of AKI with CO2 (4.1% vs. 10.0%; OR 0.449, 95% CI: 0.165-1.221, P=0.117). Patients undergoing CO2 angiography experienced a higher number of nonrenal events including limb/abdominal pain (11 vs. 0; P=0.001) and nausea/vomiting (9 vs. 1; P=0.006). Conclusions: In comparison to ICM, CO2 use is associated with a modestly reduced rate of AKI with more frequent adverse nonrenal events. In studies that use CO2 as the primary imaging agent, the average incidence of AKI remained high at 6.2%-supporting the concept that factors other than renal toxicity from ICM may contribute to renal impairment following peripheral angiography.

Original languageEnglish (US)
JournalCatheterization and Cardiovascular Interventions
StateAccepted/In press - 2017



  • Acute kidney injury
  • Angiography
  • Contrast agents
  • Peripheral/renal

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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