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

• Published in: Catheterization and cardiovascular interventions 2017-09, Vol.90 (3), p.437-448
• Main Authors: Ghumman, Saad S., Weinerman, Jonathan, Khan, Aazib, Cheema, Mubeen S., Garcia, Marlene, Levin, Daniel, Suri, Rajeev, Prasad, Anand
• Format: Article
• Language: English
• Subjects: acute kidney injury; Acute Kidney Injury - chemically induced; Acute Kidney Injury - diagnosis; Acute Kidney Injury - epidemiology; Angiography; Angiography - adverse effects; Carbon dioxide; Carbon Dioxide - administration & dosage; Carbon Dioxide - adverse effects; Cardiovascular system; Contrast agents; Contrast media; Contrast Media - administration & dosage; Contrast Media - adverse effects; Humans; Incidence; Injury analysis; Iodine Compounds - administration & dosage; Iodine Compounds - adverse effects; Kidney transplantation; Kidneys; Medical imaging; Meta-analysis; Nausea; Odds Ratio; Pain; Peripheral Arterial Disease - diagnostic imaging; Peripheral Arterial Disease - therapy; peripheral/renal; Predictive Value of Tests; Renal function; Risk Factors; Toxicity; Vomiting
• ISSN: 1522-1946; 1522-726X
• DOI: 10.1002/ccd.27051

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. © 2017 Wiley Periodicals, Inc.