Acute Kidney Injury in Patients With Cirrhosis Exposed to Iodinated Contrast: A Systematic Review and Meta-Analysis

Iodinated radiocontrast agents are widely used in diagnostic radiography and therapeutic procedures. However, concerns remain regarding their association with contrast-induced acute kidney injury (CI-AKI) and contrast-associated acute kidney injury (CA-AKI). While these risks are frequently discussed in the general population, data on CI and CA-AKI in patients with cirrhosis remains limited.

Evaluate the incidence and risk factors associated with CI-AKI or CA-AKI in patients with cirrhosis exposed to iodinated contrast (IC).

A systematic search was conducted in PubMed, Embase, and Cochrane Central for studies including patients with cirrhosis exposed to IC. Binary endpoints were assessed using pooled odds ratios (OR), and continuous endpoints using mean differences (MDs) or standardized mean differences (SMDs). The primary outcome was the pooled incidence of AKI in patients with cirrhosis exposed to IC, with secondary outcomes including the risk of CI-AKI compared to unexposed patients and risk factors associated with CA-AKI development. Analyses were performed in R (version 4.3.2).

Nine observational studies were included, two of which used propensity score matching, encompassing a total of 2389 patients with cirrhosis, of whom 1672 were exposed to IC. The pooled incidence of acute kidney injury was 11.1% (95% CI 5.3%-18.8%). On the leave-one-out analysis, patients with cirrhosis receiving IC had a higher risk of AKI compared to those not receiving IC (OR 2.5; 95% CI 1.4-4.4). The presence of ascites was significantly associated with the development of CA-AKI (OR 3.2; 95% CI 1.8-5.5). Those who developed CA-AKI had significantly higher baseline MELD scores, associated with higher serum bilirubin and INR levels.

Patients with cirrhosis exposed to IC agents had a higher risk of developing acute kidney injury compared to those not exposed. The development of CA-AKI was significantly associated with the presence of ascites and elevated baseline MELD scores, along with higher serum bilirubin and INR levels.