Beth Israel Deaconess Medical Center, Harvard Medical School Boston, MA
Vanio Antunes, MS1, Tulio L Correa, MD2, Nicole Felix, 3, Natalia J Milioli, MD4, Elisio Bulhoes, 5, Andre Milani, 6, Alonzo A Prata, 7, Otavio C Martins, MS8, Ana C Coan, 7, Pedro Romeiro, 9, Matheus V Fernandes, MHS, MD1 1Federal University of Health Sciences of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil; 2Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; 3Federal University of Campina Grande, Campina Grande, Paraiba, Brazil; 4Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil; 5College of Higher Education of the United Amazon, Redenção, Para, Brazil; 6State University of Campinas, Campinas, Sao Paulo, Brazil; 7Federal University of Espirito Santo, Vitória, Espirito Santo, Brazil; 8Juiz de Fora Federal University, Juiz de Fora, Minas Gerais, Brazil; 9University Center of Maceió, Maceió, Alagoas, Brazil
Introduction: Iodinated radiocontrast agents are widely used in diagnostic and therapeutic procedures and have been associated with concerns over contrast-induced acute kidney injury (CI-AKI) and contrast-associated acute kidney injury (CA-AKI). However, data on CI-AKI and CA-AKI incidence in patients with liver cirrhosis remains limited.
Methods: We systematically searched PubMed, Embase, and Cochrane Central for studies including patients with cirrhosis exposed to iodinated contrast up to May 2024. Binary endpoints were assessed using pooled odds ratios (OR), and continuous endpoints using mean differences (MD). A random-effects model was used to account for demographic heterogeneity among studies. Analyses were conducted in R (version 4.3.2) using the meta package.
Results: We included nine observational studies, two of which were propensity score-matched studies, encompassing 2,389 patients with cirrhosis, of whom 1,479 were exposed to iodinated contrast. In total, 149 patients developed some form of AKI. CI-AKI rates were higher in patients with cirrhosis exposed to contrast (OR 2.49; 95% 1.41 to 4.41; p = 0.002; I² = 0%). The pooled incidence of some form of CA-AKI was 10.31% (95% CI 5.30% to 19.11%; I²=92%). Presence of ascites (OR 2.929; 95% 1.749 to 4.903; p = 0; I² = 0%) and elevated baseline MELD score (MD 3.35; 95% 1.16 to 5.54; p = 0; I² = 1%) were more prevalent in patients with cirrhosis who developed CI-AKI.
Discussion: Patients with liver cirrhosis had an increased risk of CI-AKI when undergoing iodinated contrast. The presence of ascites and elevated MELD score at baseline appear to be risk factors for development of CA-AKI. These findings raise concerns for caution and increased monitoring in patients with cirrhosis undergoing contrast.
Figure: A. Forest plot of a pairwise meta-analysis comparing the incidence of contrast-associated acute kidney injury (CA-AKI) in patients with liver cirhosis undergoing iodinated contrast (IC) to the absence of IC (no IC) B. Forest plot of a single-arm meta-analysis pooling the prevalence of CA-AKI in patient with liver cirrhosis exposed to IC C. Forest plot of a pairwise meta-analysis comparing the presence of ascites at baseline in patients with cirrhosis exposed to IC who developed AKI to those who did not D. Forest plot of pairwise meta-analysis comparing meld score at baseline in patients with liver cirrhosis exposed to IC who developed AKI to those who did not
Disclosures:
Vanio Antunes indicated no relevant financial relationships.
Tulio L Correa indicated no relevant financial relationships.
Nicole Felix indicated no relevant financial relationships.
Natalia J Milioli indicated no relevant financial relationships.
Elisio Bulhoes indicated no relevant financial relationships.
Andre Milani indicated no relevant financial relationships.
Alonzo A Prata indicated no relevant financial relationships.
Otavio C Martins indicated no relevant financial relationships.
Ana C Coan indicated no relevant financial relationships.
Pedro Romeiro indicated no relevant financial relationships.
Matheus V Fernandes indicated no relevant financial relationships.
Vanio Antunes, MS1, Tulio L Correa, MD2, Nicole Felix, 3, Natalia J Milioli, MD4, Elisio Bulhoes, 5, Andre Milani, 6, Alonzo A Prata, 7, Otavio C Martins, MS8, Ana C Coan, 7, Pedro Romeiro, 9, Matheus V Fernandes, MHS, MD1. P2887 - Acute Kidney Injury in Patients With Cirrhosis Exposed to Iodinated Contrast: A Systematic Review and Meta-Analysis, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.
