Risk of Contrast-Associated Acute Kidney Injury in Patients Undergoing Peripheral Angiography with Carbon Dioxide Compared to Iodine-Containing Contrast Agents: A Systematic Review and Meta-Analysis

Gernot Wagner; Anna Glechner; Emma Persad; Irma Klerings; Gerald Gartlehner; Deddo Moertl; Sabine Steiner

doi:10.3390/jcm11237203

Risk of Contrast-Associated Acute Kidney Injury in Patients Undergoing Peripheral Angiography with Carbon Dioxide Compared to Iodine-Containing Contrast Agents: A Systematic Review and Meta-Analysis

J Clin Med. 2022 Dec 4;11(23):7203. doi: 10.3390/jcm11237203.

Authors

Gernot Wagner¹, Anna Glechner¹, Emma Persad¹, Irma Klerings¹, Gerald Gartlehner^{1

2}, Deddo Moertl^{3

4}, Sabine Steiner^{5

6}

Affiliations

¹ Department for Evidence-Based Medicine and Evaluation, University for Continuing Education Krems, Dr.-Karl-Dorrek-Strasse 30, 3500 Krems, Austria.
² RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC 27709-2194, USA.
³ Karl Landsteiner University of Health Sciences, Dr.-Karl-Dorrek-Strasse 30, 3500 Krems, Austria.
⁴ Department of Internal Medicine, University Hospital St. Poelten, Dunant-Platz 1, 3100 St. Poelten, Austria.
⁵ Department of Internal Medicine, Neurology and Dermatology, Division of Angiology, University Hospital Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany.
⁶ Helmholtz Institute for Metabolic, Obesity and Vascular Research (HI-MAG) of the Helmholtz Zentrum Muenchen, University Hospital Leipzig and University of Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany.

Abstract

The aim of this systematic review was to summarise the comparative evidence on the risk of contrast-associated acute kidney injury (CA-AKI) with CO₂ or iodinated contrast medium (ICM) for peripheral vascular interventions. We searched Ovid MEDLINE, Cochrane Library, Embase, Epistemonikos, PubMed-similar-articles, clinical trial registries, journal websites, and reference lists up to February 2022. We included studies comparing the risk of CA-AKI in patients who received CO₂ or ICM for peripheral angiography with or without endovascular intervention. Two reviewers screened the references and assessed the risk of bias of the included studies. We extracted data on study population, interventions and outcomes. For the risk of CA-AKI as our primary outcome of interest, we calculated risk ratios (RRs) with a 95% confidence interval (CI) and performed random-effects meta-analyses. We identified three RCTs and five cohort studies that fully met our eligibility criteria. Based on a random-effects meta-analysis, the risk of CA-AKI was lower with CO₂ compared to ICM (8.6% vs. 15.2%; RR, 0.59; 95% CI 0.33-1.04). Only limited results from a few studies were available on procedure and fluoroscopy time, radiation dose and CO₂-related adverse events. The evidence suggests that the use of CO₂ for peripheral vascular interventions reduces the risk of CA-AKI compared to ICM. However, due to the relevant residual risk of CA-AKI with the use of CO₂, other AKI risk factors must be considered in patients undergoing peripheral vascular interventions.

Keywords: carbon dioxide; contrast-associated acute kidney injury; peripheral angiography; peripheral vascular intervention; systematic review.

Publication types

Review

Grants and funding

This research was supported by internal funds from the Department of Evidence-based Medicine and Evaluation, University for Continuing Education Krems, Austria.