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

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.