Incidence, risk factors, and outcomes of contrast-associated acute kidney injury following interventional radiology procedures: a systematic review and meta-analysis.

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.