Incidence and risk of developing contrast-induced acute kidney injury following intravascular contrast administration in elderly patients

Abstract

Background: The purpose of this meta-analysis was to evaluate the epidemiology of contrast-induced acute kidney injury (CI-AKI) in the elderly.

Methods: A literature review was undertaken to determine the incidence of CI-AKI in individuals receiving intravascular contrast medium in the hospital setting.

Results: Twenty-two studies with 186,455 patients were identified. The pooled incidence of CI-AKI was 13.6% in 67,831 patients older than 65 years of age (95% confidence interval [CI] 10.1-18.2, I(2) =0.496). The pooled odds ratio of CI-AKI in the elderly was 2.55 (95% CI 1.85-3.52, I(2) =0.34). The high incidence of CI-AKI in the elderly was consistent across different administration route subgroups (intracoronary contrast medium group, 15.5% [95% CI 10.3-22.6]; intravenous contrast medium group, 12.4% [95% CI 8.0-18.8]).

Conclusion: Elderly patients are at greater risk for developing CI-AKI.

Keywords: angiography; contrast-induced acute kidney injury; enhanced computed tomography; epidemiology; meta-analysis.

Figure 1

Search flow diagram. Abbreviations: AKI, acute kidney injury; CI-AKI, contrast-induced acute kidney injury; CM, contrast medium; RCT, randomized controlled trial.

Figure 2

Overall incidence of CI-AKI in elderly patients (age ≥65 years). Meta-analysis of administration route stratified by pooling the reported incidences of CI-AKI from individual studies. Abbreviations: CI-AKI, contrast-induced acute kidney injury; IA, intra-arterial; IC, intracoronary; IV, intravenous; n, number of participants.

Figure 3

Odds ratios of CI-AKI in the elderly. (A) Meta-analysis of administration route stratified by pooling the calculated odds ratios based on the incidence of CI-AKI in the elderly and younger groups. (B) Meta-analysis by pooling the reported adjusted odds ratios from individual studies. Abbreviations: AKI, acute kidney injury; CI-AKI, contrast-induced acute kidney injury; CM, contrast medium; RCT, randomized controlled trial; Chi, Chi-square test; CI, confidence interval; df, degrees of freedom; IA, intra-arterial; IC, intracoronary; IV, intravenous; SD, standard deviation; SE, standard error.