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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.
Catheter Cardiovasc Interv 2017; 90(3):437-448CC

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. © 2017 Wiley Periodicals, Inc.

Authors+Show Affiliations

Department of Medicine, Division of Cardiology, The University of Texas Health Science Center, San Antonio, Texas.Department of Medicine, Division of Cardiology, The University of Texas Health Science Center, San Antonio, Texas.Department of Medicine, Division of Cardiology, The University of Texas Health Science Center, San Antonio, Texas.Department of Medicine, Division of Cardiology, The University of Texas Health Science Center, San Antonio, Texas.Department of Medicine, Division of Cardiology, The University of Texas Health Science Center, San Antonio, Texas.Department of Medicine, Division of Cardiology, The University of Texas Health Science Center, San Antonio, Texas.Department of Radiology, The University of Texas Health Science Center, San Antonio, Texas.Department of Medicine, Division of Cardiology, The University of Texas Health Science Center, San Antonio, Texas.

Pub Type(s)

Journal Article
Meta-Analysis
Review
Systematic Review

Language

eng

PubMed ID

28463460

Citation

Ghumman, Saad S., et al. "Contrast Induced-acute Kidney Injury Following Peripheral Angiography With Carbon Dioxide Versus Iodinated Contrast Media: a Meta-analysis and Systematic Review of Current Literature." Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions, vol. 90, no. 3, 2017, pp. 437-448.
Ghumman SS, Weinerman J, Khan A, et al. Contrast induced-acute kidney injury following peripheral angiography with carbon dioxide versus iodinated contrast media: A meta-analysis and systematic review of current literature. Catheter Cardiovasc Interv. 2017;90(3):437-448.
Ghumman, S. S., Weinerman, J., Khan, A., Cheema, M. S., Garcia, M., Levin, D., ... Prasad, A. (2017). Contrast induced-acute kidney injury following peripheral angiography with carbon dioxide versus iodinated contrast media: A meta-analysis and systematic review of current literature. Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions, 90(3), pp. 437-448. doi:10.1002/ccd.27051.
Ghumman SS, et al. Contrast Induced-acute Kidney Injury Following Peripheral Angiography With Carbon Dioxide Versus Iodinated Contrast Media: a Meta-analysis and Systematic Review of Current Literature. Catheter Cardiovasc Interv. 2017 Sep 1;90(3):437-448. PubMed PMID: 28463460.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Contrast induced-acute kidney injury following peripheral angiography with carbon dioxide versus iodinated contrast media: 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, Y1 - 2017/05/02/ PY - 2017/01/27/received PY - 2017/02/15/revised PY - 2017/03/03/accepted PY - 2017/5/4/pubmed PY - 2018/5/22/medline PY - 2017/5/3/entrez KW - acute kidney injury KW - angiography KW - contrast agents KW - peripheral/renal SP - 437 EP - 448 JF - Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions JO - Catheter Cardiovasc Interv VL - 90 IS - 3 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. © 2017 Wiley Periodicals, Inc. SN - 1522-726X UR - https://www.unboundmedicine.com/medline/citation/28463460/Contrast_induced_acute_kidney_injury_following_peripheral_angiography_with_carbon_dioxide_versus_iodinated_contrast_media:_A_meta_analysis_and_systematic_review_of_current_literature_ L2 - https://doi.org/10.1002/ccd.27051 DB - PRIME DP - Unbound Medicine ER -