Visual Abstract

Background: It is important for medical practitioners to be aware of the effect of iodinated contrast media on the residual renal function (RRF) of dialysis patients who require diagnostic or therapeutic imaging procedures. Preservation of RRF is important given that it is a robust predictor of higher survival. However, the absence of any effect would allow for easier diagnostic or therapeutic imaging tests to be performed. Objective: This systematic review with meta-analysis will quantify the effect of intravascular administration of iodinated contrast on the residual function of adult dialysis patients. Study Design: The selection criteria included adult (age ≥ 18 years) populations undergoing dialysis, who have been administered an intravascular contrast. The primary outcome was the measurement of residual function. Secondary outcomes were disease progression from peritoneal dialysis to hemodialysis, hospitalization following contrast administration, and all-cause mortality. Results: Nine studies including 434 patients met the inclusion criteria. A meta-analysis was performed on 7 trials with complete quantitative data. The weighted difference in means was −0.16 mL/min (95% confidence interval −0.66 to 0.34 mL/min; p = 0.53), suggesting a small reduction in residual function following contrast administration. Significant heterogeneity in the data was observed, with a Cochran Q of 35.83 and an I2 of 83.25 (p < 0.0001). Subgroup analysis of retrospective versus prospective study design resolved heterogeneity. Few data were reported for clinical outcomes. Limitations: Small sample size of included studies. Conclusion: Intravascularly administered contrast media may not result in a significant reduction of residual function in dialysis patients.

1.
Gruberg
L
,
Mehran
R
,
Dangas
G
,
Mintz
GS
,
Waksman
R
,
Kent
KM
, et al
Acute renal failure requiring dialysis after percutaneous coronary interventions
.
Cathet Cardiovasc Interv
.
2001
;
52
:
409
16
.
2.
Hou
SH
,
Bushinsky
DA
,
Wish
JB
,
Cohen
JJ
,
Harrington
JT
.
Hospital-acquired renal insufficiency: a prospective study
.
Am J Med
.
1983
;
74
:
243
8
.
3.
Kjaergaard
KD
,
Jensen
JD
,
Peters
CD
,
Jespersen
B
.
Preserving residual renal function in dialysis patients: an update on evidence to assist clinical decision making
.
Clin Kidney J
.
2011
;
4
:
225
30
.
4.
Weisbord
SD
,
Bernardini
J
,
Mor
MK
,
Hartwig
KC
,
Nicoletta
PJ
,
Palevsky
PM
, et al
The effect of coronary angiography on residual renal function in patients on peritoneal dialysis
.
Clin Cardiol
.
2006
;
29
:
494
7
.
5.
Diaz-Buxo
JA
,
White
SA
,
Himmele
R
.
The importance of residual renal function in peritoneal dialysis patients
.
Adv Perit Dial
.
2013
;
29
:
19
24
.
6.
Termorshuizen
F
,
Dekker
FW
,
van Manen
JG
,
Korevaar
JC
,
Boeschoten
EW
,
Krediet
RT
.
Relative contribution of residual renal function and different measures of adequacy to survival in hemodialysis patients: an analysis of the Netherlands Cooperative Study on the Adequacy of Dialysis (NECOSAD)-2
.
J Am Soc Nephrol
.
2004
;
15
:
1061
70
.
7.
Wang
AY
,
Lai
KN
.
The importance of residual renal function in dialysis patients
.
Kidney Int
.
2006
;
69
:
1726
32
.
8.
Chertow
GM
,
Normand
SL
,
McNeil
BJ
.
“Renalism”: inappropriately low rates of coronary angiography in elderly individuals with renal insufficiency
.
J Am Soc Nephrol
.
2004
;
15
:
2462
8
.
9.
Dittrich
E
,
Puttinger
H
,
Schillinger
M
,
Lang
I
,
Stefenelli
T
,
Horl
WH
, et al
Effect of radio contrast media on residual renal function in peritoneal dialysis patients – a prospective study
.
Nephrol Dial Transplant
.
2006
;
21
:
1334
9
.
10.
Moranne
O
,
Willoteaux
S
,
Pagniez
D
,
Dequiedt
P
,
Boulanger
E
.
Effect of iodinated contrast agents on residual renal function in PD patients
.
Nephrol Dial Transplant
.
2006
;
21
:
1040
5
.
11.
Liu
X
,
Dai
C
.
Advances in understanding and management of residual renal function in patients with chronic kidney disease
.
Kidney Dis
.
2017
;
2
:
187
96
.
12.
Wells
GA
,
Shea
B
,
O’Connell
D
,
Peterson
J
,
Welch
V
,
Losos
M
, et al
The Newcastle-Ottawa scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses
.
Ottawa
:
Ottawa Hospital Research Institute
;
2013
[cited 2017 Jul 3]. Available from
: http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp.
13.
Hozo
SP
,
Djulbegovic
B
,
Hozo
I
.
Estimating the mean and variance from the median, range, and the size of a sample
.
BMC Med Res Methodol
.
2005
;
5
:
13
.
14.
Lee
DK
,
In
J
,
Lee
S
.
Standard deviation and standard error of the mean
.
Korean J Anesthesiol
.
2015
;
68
:
220
3
.
15.
DerSimonian
R
,
Laird
N
.
Meta-analysis in clinical trials
.
Control Clin Trials
.
1986
;
7
:
177
88
.
16.
Egger
M
,
Davey Smith
G
,
Schneider
M
,
Minder
C
.
Bias in meta-analysis detected by a simple, graphical test
.
BMJ
.
1997
;
315
:
629
34
.
17.
Duval
S
,
Tweedie
R
.
Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis
.
Biometrics
.
2000
;
56
:
455
63
.
18.
Moher
D
,
Altman
DG
,
Liberati
A
,
Tetzlaff
J
.
PRISMA statement
.
Epidemiology
.
2011
;
22
:
128
.
19.
Moher
D
,
Liberati
A
,
Tetzlaff
J
,
Altman
DG
.
Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement
.
Int J Surg
.
2010
;
8
:
336
41
.
20.
Hassan
K
,
Fadi
H
.
Is hypoalbuminemia a prognostic risk factor for contrast-induced nephropathy in peritoneal dialysis patients?
Therapeut Clin Risk Manag
.
2014
;
10
:
787
95
.
21.
Herget-Rosenthal
S
,
von Ostrowski
M
,
Kribben
A
.
Definition and risk factors of rapidly declining residual renal function in peritoneal dialysis: an observational study
.
Kidney Blood Press Res
.
2012
;
35
:
233
41
.
22.
Iwamoto
M
,
Hiroshige
K
,
Suda
T
,
Ohta
T
,
Ohtani
A
,
Nakashima
Y
.
Elimination of iomeprol in patients undergoing continuous ambulatory peritoneal dialysis
.
Perit Dial Int
.
1999
;
19
:
380
5
.[Pubmed partial-iss]
23.
Janousek
R
,
Krajina
A
,
Peregrin
JH
,
Dusilova-Sulkova
S
,
Renc
O
,
Hajek
J
, et al
Effect of intravascular iodinated contrast media on natural course of end-stage renal disease progression in hemodialysis patients: a prospective study
.
Cardiovasc Intervent Radiol
.
2010
;
33
:
61
6
.
24.
Kim
IY
,
Lee
SB
,
Lee
DW
,
Song
SH
,
Seong
EY
,
Kwak
IS
.
Long-term effect of radiocontrast-enhanced computed tomography on the renal function of chronic kidney disease patients
.
Clin Exp Nephrol
.
2012
;
16
:
755
9
.
25.
Swan
S
,
Halstenson
C
,
Kasiske
B
,
Collins
A
.
Determination of residual renal function with iohexol clearance in hemodialysis patients
.
Kidney Int
.
1996
;
49
:
232
5
.
26.
Katzberg
RW
,
Barrett
BJ
.
Risk of iodinated contrast material–induced nephropathy with intravenous administration
.
Radiology
.
2007
;
243
:
622
8
.
27.
Taskapan
H
,
Theodoros
P
,
Tam
P
,
Bargman
J
,
Oreopoulos
D
.
Glomerular filtration rate (GFR) estimated from serum creatinine predicts total (urine and peritoneal) creatinine clearance in patients on peritoneal dialysis
.
Int Urol Nephorol
.
2010
;
42
:
1085
92
.
28.
McDonald
JS
,
McDonald
RJ
,
Carter
RE
,
Katzberg
RW
,
Kallmes
DF
,
Williamson
EE
.
Risk of intravenous contrast material-mediated acute kidney injury: a propensity score-matched study stratified by baseline-estimated glomerular filtration rate
.
Radiology
.
2014
;
271
:
65
73
.
29.
McDonald
RJ
,
McDonald
JS
,
Carter
RE
,
Hartman
RP
,
Katzberg
RW
,
Kallmes
DF
, et al
Intravenous contrast material exposure is not an independent risk factor for dialysis or mortality
.
Radiology
.
2014
;
273
:
714
25
.
30.
Newhouse
JH
,
Kho
D
,
Rao
QA
,
Starren
J
.
Frequency of serum creatinine changes in the absence of iodinated contrast material: implications for studies of contrast nephrotoxicity
.
Am J Roentgenol
.
2008
;
191
:
376
82
.
31.
Bragg-Gresham
JL
,
Fissell
RB
,
Mason
NA
,
Bailie
GR
,
Gillespie
BW
,
Wizeman
V
, et al
Diuretic use, residual renal function, and mortality among hemodialysis patients in the Dialysis Outcomes and Practice Pattern Study (DOPPS)
.
Am J Kidney Dis
.
2007
;
49
:
426
31
.
32.
Schieda
N
,
Blaichman
JI
,
Costa
AF
,
Glikstein
R
,
Hurrell
C
,
James
M
, et al
Gadolinium-based contrast agents in kidney disease: a comprehensive review and clinical practice guideline issued by the Canadian association of radiologists
.
Can Assoc Radiol J
.
2018
;
69
:
136
50
.
33.
Nijssen
EC
,
Rennenberg
RJ
,
Nelemans
PJ
,
Essers
BA
,
Janssen
MM
,
Vermeeren
MA
, et al
Prophylactic hydration to protect renal function from intravascular iodinated contrast material in patients at high risk of contrast-induced nephropathy (AMACING): a prospective, randomised, phase 3, controlled, open-label, non-inferiority trial
.
Lancet
.
2017
;
389
:
1312
22
.
34.
Rosenstock
JL
,
Bruno
R
,
Kim
JK
,
Lubarsky
L
,
Schaller
R
,
Panagopoulos
G
, et al
The effect of withdrawal of ACE inhibitors or angiotensin receptor blockers prior to coronary angiography on the incidence of contrast-induced nephropathy
.
Int Urol Nephrol
.
2008
;
40
:
749
55
.
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