Abstract
Contrast-Induced Nephropathy in Patients with Cirrhosis: A Systematic Review and Meta-Analysis
Bea Regine Panganiban, MD; Jayson Villavicencio, MD; Eric Yasay, MD; Janice Jill Lao, MD
University of the Philippines – Philippine General Hospital
Significance: Contrast-induced acute kidney injury represents a significant concern with liver cirrhosis, who may possess unique risk factors for developing contrast-induced nephropathy (CIN). Studies reporting the nephrotoxic potential of contrast agents in this population are limited. We aim to determine if the use of contrast agents for imaging procedures among patients with cirrhosis is associated with the development of CIN.
Methodology: A comprehensive search for databases of randomized controlled trials (RCTs) and observational studies comparing contrast-enhanced imaging versus non-contrast studies for CIN among adult patients with cirrhosis was done. PubMed, EMBASE, Cochrane library, and ClinicalTrials.gov were searched using relevant terms including cirrhosis, CIN or contrast associated acute kidney injury (AKI) until October 2023. Data extraction was performed using a standardized data form, and any discrepancies were resolved by consensus among the authors. Data were pooled and analyzed using Review Manager Software version 5.4 as a systematic review and meta-analysis.
Results: A total of nine studies were included in the systematic review, with reported incidence of CIN ranging from 2.5-5%. Two prospective (n=385) and two retrospective (n=604) observational studies were included in the meta-analysis. The contrast group was associated with an increased risk for CIN, OR 2.52, 95% CI, 1.52-4.16. Risk factors predisposing patients with cirrhosis to CIN include ascites and presence of infection (OR 2.796, 95% C: 1.109–7.052; OR 22.18, 95% CI 2.87-171.22, p=0.003 respectively).
Conclusion: Available evidence suggests that cirrhotic patients exposed to contrast agents face a heightened risk of AKI, necessitating careful monitoring during contrast-enhanced imaging procedures.
Important Dates to Remember
| JRRE Activities 2023-2024 |
Proposed Dates |
|---|---|
| Resumption of face-to-face Evidence-Based Medicine Workshop Venue to be announced once finalized. |
July 21, 2023 (Friday), 1-5pm |
| Monthly Critical Appraisal of Topics Conferences to be gaciliated by Research Coordinators per Institution | Monthly Critical Appraisal of Topics Conferences per Institution |
| CAT Plenary/Liver Con Dates: September 23, 2023 December 16, 2023 March 2024 (During the JAC) Resumption of face-to-face Quarterly Critical Appraisal of Topics facilitated by the JRRE |
2 Clinical scenarios and articles are to be sent to institutions each on August 2023, November 2023, and February 2024; |
| Hybrid Research Workshop 4 week asynchronous via Moodle, followed by a 1 day on-site Onsite Workshop Research Protocol Presentation for Level I GI Fellows-In-Training - Research Protocol Presentation: August 12, 2023 - Research Forums of the Tripartite Societies |
Week 1: July 15-21, 2023 Week 2: July 22-28, 2023 Week 3: July 29-August 4, 2023 Week 4: August 5-11, 2023 |
| Research Manuscript Workshop for level II GI Fellows-In-Training | January 6, 2024 |