Contrast induced nephropathy in patients undergoing intravenous (IV) contrast enhanced computed tomography (CECT) and the relationship with risk factors: A meta-analysis

• Published in: European journal of radiology 2013-09, Vol.82 (9), p.e387-e399
• Main Authors: Moos, Shira I, van Vemde, David N.H, Stoker, Jaap, Bipat, Shandra
• Format: Article
• Language: English
• Subjects: Adult; Age Distribution; Aged; Aged, 80 and over; Comorbidity; Computed tomography; Contrast Media; Contrast medium; Diabetes Mellitus - epidemiology; Drug-Related Side Effects and Adverse Reactions - epidemiology; Humans; Incidence; Injections, Intravenous - statistics & numerical data; Iodine; Kidney Diseases - epidemiology; Male; Middle Aged; Neoplasms; Nephropathy; Prevention; Radiology; Risk Factors; Tomography, X-Ray Computed - statistics & numerical data
• ISSN: 0720-048X; 1872-7727
• DOI: 10.1016/j.ejrad.2013.04.029

Abstract Purpose To summarize the incidence of contrast-induced nephropathy (CIN) and associations between CIN incidence and risk factors in patients undergoing intravenous contrast-enhanced computed tomography (CECT) with low- or iso-osmolar iodinated contrast medium. Methods This review is performed in accordance with the preferred reporting items in systematic reviews and meta-analysis (PRISMA) guidelines. We searched the MEDLINE, EMBASE and Cochrane databases from 2002 till November 2012. Two reviewers included papers and extracted data. The pooled data were analysed by either fixed or random-effects approach depending on heterogeneity defined as the I2 index. Results 42 articles with 18,790 patients (mean age 61.5 years (range: 38–83 years)) were included. The mean baseline eGFR was 59.8 mL/min and ranged from 4 to 256 mL/min. Of all patients 45.0% had an estimated glomerular filtration rate (eGFR) < 60 mL/min, 55.2% had hypertension; 20.2% had diabetes mellitus (DM) and 6.5% had congestive heart failure (CHF). The overall pooled CIN incidence, defined as a SCr increase of ≥25% or ≥0.5 mg/dL, was 4.96% (95%CI: 3.79–6.47). Data analysis showed associations between CIN and the presence of renal insufficiency, DM, malignancy, age > 65 years and use of non-steroidal anti-inflammatory drugs (NSAID's) with odds ratios of 1.73 (95%CI: 1.06–2.82), 1.87 (95%CI: 1.55–2.26), 1.79 (95%CI: 1.03–3.11), 1.95 (95%CI: 1.02–3.70) and 2.32 (95%CI: 1.04–5.19), respectively while hypertension, anaemia and CFH were not associated ( p = 0.13, p = 0.38, p = 0.40). Conclusion The mean incidence of CIN after intravenous iodinated CECT was low and associated with renal insufficiency, diabetes, presence of malignancy, old age and NSAID's use.