Frontiers in radiology · 2026
Incidence, risk factors, and outcomes of contrast-associated acute kidney injury following interventional radiology procedures: a systematic review and meta-analysis.
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Alhumaid Saad, Almulhim Mohammed Yousef, Al Hussaini Hessah Abdulaziz, Alalwan Qasem M, Almohammed Ali Hani, Al Ruzaihan Sarah A, Aborshaid Fatima A, Al Abdulqader Abdulrhman Khaled, Al Dossary Nourah, Alabdulqader Muneera, AlMousa Shaden Saleh, Aljoqiman Khalid Suliman
Аннотация
BACKGROUND: Contrast-associated acute kidney injury (CA-AKI) is a recognized complication of iodinated contrast administration. Although extensively studied in coronary angiography, its incidence, associated factors, and outcomes following interventional radiology and other non-coronary endovascular procedures remain incompletely characterized. We evaluated the incidence, associated factors, and outcomes of CA-AKI in these populations.
METHODS: This systematic review followed PRISMA 2020 guidelines and a prospectively registered PROSPERO protocol (CRD420261385592). PubMed/MEDLINE, Embase, Scopus, CINAHL, and Web of Science were searched from inception to 30 April 2026. Eligible studies evaluated CA-AKI following catheter-based non-coronary endovascular or interventional radiology procedures. Random-effects meta-analysis estimated pooled incidence, with subgroup and sensitivity analyses.
RESULTS: Thirty-nine studies were included, of which 38 contributed to the meta-analysis. The pooled CA-AKI incidence was 6.91% (95% CI 5.69-8.24; I2 = 89.5%). In a sensitivity analysis restricted to patient-level estimates (30 studies; 16,825 unique patients), incidence was 7.27% (95% CI 5.77-8.92; I2 = 91.5%). Leave-one-out estimates ranged from 6.56% to 7.16%, indicating numerical stability despite substantial heterogeneity. Exploratory subgroup analysis showed higher pooled incidence following embolization/interventional oncology than neuroendovascular/carotid procedures (8.44% vs. 5.48%; p = 0.0171), although substantial residual heterogeneity renders this finding hypothesis-generating. Frequently reported associated factors included baseline renal dysfunction, advanced liver disease, diabetes mellitus, anaemia, hypoalbuminaemia, inflammatory burden, and greater contrast exposure. Heterogeneous observational evidence did not establish a clinically reliable contrast-volume threshold. Across individual studies, CA-AKI was associated with increased mortality, poorer functional outcomes, prolonged hospitalisation, and persistent renal dysfunction, although associations were not consistent across all studies and outcomes.
CONCLUSION: CA-AKI occurs after a range of non-coronary endovascular and interventional radiology procedures and may be associated with clinically important adverse outcomes. Substantial heterogeneity limits the generalizability of a single pooled incidence estimate, and procedure- and population-specific estimates should remain central to interpretation. Standardised definitions and prospective multicentre studies are needed to establish procedure-specific risk profiles and clinically useful preventive strategies.
SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261385592, PROSPERO, CRD420261385592.
METHODS: This systematic review followed PRISMA 2020 guidelines and a prospectively registered PROSPERO protocol (CRD420261385592). PubMed/MEDLINE, Embase, Scopus, CINAHL, and Web of Science were searched from inception to 30 April 2026. Eligible studies evaluated CA-AKI following catheter-based non-coronary endovascular or interventional radiology procedures. Random-effects meta-analysis estimated pooled incidence, with subgroup and sensitivity analyses.
RESULTS: Thirty-nine studies were included, of which 38 contributed to the meta-analysis. The pooled CA-AKI incidence was 6.91% (95% CI 5.69-8.24; I2 = 89.5%). In a sensitivity analysis restricted to patient-level estimates (30 studies; 16,825 unique patients), incidence was 7.27% (95% CI 5.77-8.92; I2 = 91.5%). Leave-one-out estimates ranged from 6.56% to 7.16%, indicating numerical stability despite substantial heterogeneity. Exploratory subgroup analysis showed higher pooled incidence following embolization/interventional oncology than neuroendovascular/carotid procedures (8.44% vs. 5.48%; p = 0.0171), although substantial residual heterogeneity renders this finding hypothesis-generating. Frequently reported associated factors included baseline renal dysfunction, advanced liver disease, diabetes mellitus, anaemia, hypoalbuminaemia, inflammatory burden, and greater contrast exposure. Heterogeneous observational evidence did not establish a clinically reliable contrast-volume threshold. Across individual studies, CA-AKI was associated with increased mortality, poorer functional outcomes, prolonged hospitalisation, and persistent renal dysfunction, although associations were not consistent across all studies and outcomes.
CONCLUSION: CA-AKI occurs after a range of non-coronary endovascular and interventional radiology procedures and may be associated with clinically important adverse outcomes. Substantial heterogeneity limits the generalizability of a single pooled incidence estimate, and procedure- and population-specific estimates should remain central to interpretation. Standardised definitions and prospective multicentre studies are needed to establish procedure-specific risk profiles and clinically useful preventive strategies.
SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261385592, PROSPERO, CRD420261385592.