Shira I. Moos MD, MMedSc, Presenter: Nothing to Disclose

David N.H. van Vemde, Abstract Co-Author: Nothing to Disclose

Jaap Stoker MD, PhD, Abstract Co-Author: Research Consultant, Robarts Clinical Trials

Shandra Bipat MS, Abstract Co-Author: Nothing to Disclose

To assess incidence and relation between contrast induced nephropathy (CIN) and long term adverse events in intravenous contrast enhanced computed tomography (CECT) patients.

A systematic review and meta-analysis according to the Preferred Reporting Items in Systematic reviews and Meta-Analysis guidelines was performed. We searched MEDLINE, EMBASE and Cochrane from 2002 till November 2013. Two reviewers selected relevant papers en extracted data. Data were pooled with a fixed or random effect model depending on variation in data (Akaike information criterion, I2).

We included 15 studies, containing 4,455 patients. We found a mean incidence of: 51.52% chronic kidney disease, 22.60% diabetes mellitus, 25.55% cardiovascular disease and 9.12% use of nephrotoxic medication. Mean incidence of CIN was: 8.20%(95%CI:4.98-13.21). Incidence of the adverse events permanent renal failure, renal replacement therapy and death was: 13.28%(95%CI:5.57-28.45), 0.50%(95%CI:0.13-1.98), and 13.46%(95%CI:6.55-25.65). The risk difference for permanent renal failure between CIN patients and patients without CIN was: 0.07(95%CI:-0.05-020), I2=53%, p=0.25, for renal replacement therapy: 0.05(95%CI:-0.07-0.16), I2=81%, p=0.41 and for death: 0.15(95%CI:0.02-0.29), I2=0%, p=0.03.

CIN is not related with increased risk for permanent renal failure and renal replacement therapy after intravenous CECT. Despite the statistical association it is questionable if death is a manifestation of CIN rather than a manifestation of pre-existing co-morbidity. 

We describe a meta-analysis in which we assess relation between contrast induced nephropathy (CIN) and adverse events, i.e. permanent renal failure, renal replacement therapy and death, after intravenous contrast enhanced computed tomography (CECT). It has become clear that CIN incidence after intravenous contrast enhanced computed tomography is low. Previous literature assessments show that adverse events rarely occur after CIN in this particular group of patients and it is questionable if these events can be attributed to CIN or more specific intravenous CECT. To our knowledge this is the first systematic review and meta-analysis on this topic. We therefore believe that the results of our meta-analysis could lead to re-evaluation of prevention measures in patients undergoing intravenous contrast enhanced computed tomography. 

Moos, S, van Vemde, D, Stoker, J, Bipat, S, Contrast Induced Nephropathy and Adverse Events in the Long Term after Intravenous Contrast Enhanced Computed Tomography. A Meta-analysis.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14007966.html