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
The aim of this systematic review was to summarise the comparative evidence on the risk of contrast-associated acute kidney injury (CA-AKI) with CO<sub>2</sub> or iodinated contrast medium (ICM) for peripheral vascular interventions. We searched Ovid MEDLINE, Cochrane Library, Embase, Ep...
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| Format: | Article |
| Language: | English |
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MDPI AG
2022-12-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/11/23/7203 |
| _version_ | 1797462866498945024 |
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| author | Gernot Wagner Anna Glechner Emma Persad Irma Klerings Gerald Gartlehner Deddo Moertl Sabine Steiner |
| author_facet | Gernot Wagner Anna Glechner Emma Persad Irma Klerings Gerald Gartlehner Deddo Moertl Sabine Steiner |
| author_sort | Gernot Wagner |
| collection | DOAJ |
| description | The aim of this systematic review was to summarise the comparative evidence on the risk of contrast-associated acute kidney injury (CA-AKI) with CO<sub>2</sub> 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 CO<sub>2</sub> 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 CO<sub>2</sub> 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 CO<sub>2</sub>-related adverse events. The evidence suggests that the use of CO<sub>2</sub> 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 CO<sub>2</sub>, other AKI risk factors must be considered in patients undergoing peripheral vascular interventions. |
| first_indexed | 2024-03-09T17:42:36Z |
| format | Article |
| id | doaj.art-65151a154abb4c1ea02364793eeccc6f |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-09T17:42:36Z |
| publishDate | 2022-12-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-65151a154abb4c1ea02364793eeccc6f2023-11-24T11:24:40ZengMDPI AGJournal of Clinical Medicine2077-03832022-12-011123720310.3390/jcm11237203Risk 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-AnalysisGernot Wagner0Anna Glechner1Emma Persad2Irma Klerings3Gerald Gartlehner4Deddo Moertl5Sabine Steiner6Department for Evidence-Based Medicine and Evaluation, University for Continuing Education Krems, Dr.-Karl-Dorrek-Strasse 30, 3500 Krems, AustriaDepartment for Evidence-Based Medicine and Evaluation, University for Continuing Education Krems, Dr.-Karl-Dorrek-Strasse 30, 3500 Krems, AustriaDepartment for Evidence-Based Medicine and Evaluation, University for Continuing Education Krems, Dr.-Karl-Dorrek-Strasse 30, 3500 Krems, AustriaDepartment for Evidence-Based Medicine and Evaluation, University for Continuing Education Krems, Dr.-Karl-Dorrek-Strasse 30, 3500 Krems, AustriaDepartment for Evidence-Based Medicine and Evaluation, University for Continuing Education Krems, Dr.-Karl-Dorrek-Strasse 30, 3500 Krems, AustriaKarl Landsteiner University of Health Sciences, Dr.-Karl-Dorrek-Strasse 30, 3500 Krems, AustriaDepartment of Internal Medicine, Neurology and Dermatology, Division of Angiology, University Hospital Leipzig, Liebigstrasse 20, 04103 Leipzig, GermanyThe aim of this systematic review was to summarise the comparative evidence on the risk of contrast-associated acute kidney injury (CA-AKI) with CO<sub>2</sub> 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 CO<sub>2</sub> 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 CO<sub>2</sub> 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 CO<sub>2</sub>-related adverse events. The evidence suggests that the use of CO<sub>2</sub> 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 CO<sub>2</sub>, other AKI risk factors must be considered in patients undergoing peripheral vascular interventions.https://www.mdpi.com/2077-0383/11/23/7203contrast-associated acute kidney injuryperipheral angiographyperipheral vascular interventioncarbon dioxidesystematic review |
| spellingShingle | Gernot Wagner Anna Glechner Emma Persad Irma Klerings Gerald Gartlehner Deddo Moertl Sabine Steiner 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 Journal of Clinical Medicine contrast-associated acute kidney injury peripheral angiography peripheral vascular intervention carbon dioxide systematic review |
| title | 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 |
| title_full | 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 |
| title_fullStr | 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 |
| title_full_unstemmed | 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 |
| title_short | 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 |
| title_sort | 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 |
| topic | contrast-associated acute kidney injury peripheral angiography peripheral vascular intervention carbon dioxide systematic review |
| url | https://www.mdpi.com/2077-0383/11/23/7203 |
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