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Contrast induced‐acute kidney injury following peripheral angiography with carbon dioxide versus iodinated contrast media: A meta‐analysis and systematic review of current literature
Author(s) -
Ghumman Saad S.,
Weinerman Jonathan,
Khan Aazib,
Cheema Mubeen S.,
Garcia Marlene,
Levin Daniel,
Suri Rajeev,
Prasad Anand
Publication year - 2017
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.27051
Subject(s) - medicine , acute kidney injury , iodinated contrast , incidence (geometry) , iopamidol , meta analysis , kidney disease , nausea , randomized controlled trial , adverse effect , subgroup analysis , surgery , radiology , contrast medium , computed tomography , physics , optics
Objective We conducted a meta‐analysis to compare the incidence of acute kidney injury (AKI) with carbon dioxide (CO 2 ) versus iodinated contrast media (ICM). Background Contrast induced‐acute kidney injury (CI‐AKI) is a known complication following endovascular procedures with ICM. CO 2 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, CO 2 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 CO 2 (4.1% vs. 10.0%; OR 0.449, 95% CI: 0.165–1.221, P = 0.117). Patients undergoing CO 2 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, CO 2 use is associated with a modestly reduced rate of AKI with more frequent adverse nonrenal events. In studies that use CO 2 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.