Contrast-induced acute kidney injury among patients with chronic kidney disease undergoing imaging studies: A meta-analysis

Yen Chien Lee, Chung Cheng Hsieh, Ting Tsung Chang, Chung Yi Li

Research output: Contribution to journalArticle

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Abstract

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.

Original languageEnglish
Pages (from-to)728-735
Number of pages8
JournalAmerican Journal of Roentgenology
Volume213
Issue number4
DOIs
Publication statusPublished - 2019 Jan 1

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Chronic Renal Insufficiency
Acute Kidney Injury
Meta-Analysis
Contrast Media
Glomerular Filtration Rate
Kidney
Retrospective Studies
PubMed
MEDLINE
Publications
Cohort Studies
Odds Ratio

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging

Cite this

@article{1f9e5f76893444f5ac9f1602b67b2728,
title = "Contrast-induced acute kidney injury among patients with chronic kidney disease undergoing imaging studies: A meta-analysis",
abstract = "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.",
author = "Lee, {Yen Chien} and Hsieh, {Chung Cheng} and Chang, {Ting Tsung} and Li, {Chung Yi}",
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Contrast-induced acute kidney injury among patients with chronic kidney disease undergoing imaging studies : A meta-analysis. / Lee, Yen Chien; Hsieh, Chung Cheng; Chang, Ting Tsung; Li, Chung Yi.

In: American Journal of Roentgenology, Vol. 213, No. 4, 01.01.2019, p. 728-735.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Contrast-induced acute kidney injury among patients with chronic kidney disease undergoing imaging studies

T2 - A meta-analysis

AU - Lee, Yen Chien

AU - Hsieh, Chung Cheng

AU - Chang, Ting Tsung

AU - Li, Chung Yi

PY - 2019/1/1

Y1 - 2019/1/1

N2 - 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.

AB - 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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