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

4 Citations (Scopus)

Abstract

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
DOIs
StateAccepted/In press - 2017

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Acute Kidney Injury
Carbon Dioxide
Contrast Media
Meta-Analysis
Angiography
Incidence
Kidney
Publication Bias
Endovascular Procedures
Chronic Renal Insufficiency
Nausea
Abdominal Pain
Vomiting
Observational Studies
Extremities
Randomized Controlled Trials
Databases

Keywords

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

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

@article{19967f9d2b2841cda4d06556fd341161,
title = "Contrast induced-acute kidney injury following peripheral angiography with carbon dioxide versus iodinated contrast media: A meta-analysis and systematic review of current literature",
abstract = "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.",
keywords = "Acute kidney injury, Angiography, Contrast agents, Peripheral/renal",
author = "Ghumman, {Saad S.} and Jonathan Weinerman and Aazib Khan and Cheema, {Mubeen S.} and Marlene Garcia and Daniel Levin and Rajeev Suri and Anand Prasad",
year = "2017",
doi = "10.1002/ccd.27051",
language = "English (US)",
journal = "Catheterization and Cardiovascular Interventions",
issn = "1522-1946",
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TY - JOUR

T1 - Contrast induced-acute kidney injury following peripheral angiography with carbon dioxide versus iodinated contrast media

T2 - A meta-analysis and systematic review of current literature

AU - Ghumman, Saad S.

AU - Weinerman, Jonathan

AU - Khan, Aazib

AU - Cheema, Mubeen S.

AU - Garcia, Marlene

AU - Levin, Daniel

AU - Suri, Rajeev

AU - Prasad, Anand

PY - 2017

Y1 - 2017

N2 - 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.

AB - 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.

KW - Acute kidney injury

KW - Angiography

KW - Contrast agents

KW - Peripheral/renal

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