Contrast-Induced Acute Kidney Injury Among Patients With Chronic Kidney Disease Undergoing Imaging Studies: A Meta-Analysis.
AJR Am J Roentgenol. 2019 Oct;213(4):728-735. doi: 10.2214/AJR.19.21309. Epub 2019 Aug 6.
Lee YC, Hsieh CC, Chang TT, Li CY.
OBJECTIVE. Contrast-induced nephropathy (CIN) generally is the main concern for patients with chronic kidney disease (CKD) undergoing contrast-enhanced imaging. To evaluate the risk of nephropathy induced by IV contrast medium (CM) in patients with CKD, we performed a meta-analysis.
MATERIALS AND METHODS. We searched for PubMed and MEDLINE articles that were published up to October 3, 2018, contained the phrase "contrast medium" or "contrast media" and the word "renal," and included patients with CKD and a proper control group. The publications that were identified were reviewed, and only studies that used an IV route of CM administration were selected. Subgroup analysis was performed according to the estimated glomerular filtration rate.
RESULTS. Six studies including 55,963 participants were selected. The Peto method and random-effects model were applied. IV infusion of CM did not lead to the deterioration of renal function in patients with CKD compared with those without CKD (odds ratio [OR], 1.07; 95% CI, 0.98-1.17; I2, 35.3%). As the estimated glomerular filtration rate decreased, fewer patients received IV CM. The ORs for CIN on the basis of CKD stage were as follows: 1.11 (95% CI, 0.95-1.30; I2, 4.0%) for stage 2 CKD, 1.05 (95% CI, 0.93-1.18, I2, 48.3%) for CKD lower than stage 3, 1.06 (95% CI, 0.94-1.19; I2, 32.0%) for stage 3 CKD, 1.08 (95% CI, 0.84-1.39; I2, 44.6%) for CKD lower than stage 4, 0.86 (95% CI, 0.37-2.00) for stage 4 CKD, and 0.26 (95% CI, 0.02-3.4) for stage 5 CKD in one study only. All analyses showed the lack of difference in the ORs for CIN between participants who received IV injection of CM and those who did not.
CONCLUSION. Retrospective cohort studies of IV radiographic CM have failed to show renal damage in patients with CKD. This retrospective study is limited, and other risk factors for CIN might not be distributed evenly.
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