Impact of contrast agents on renal function: A systematic review
DOI:
https://doi.org/10.59471/ijhsc2025236Keywords:
Contrast Media, Iodine, Gadolinium, Acute Kidney Injury, Diagnostic Imaging, Intravascular AdministrationAbstract
Background: Radiological contrast agents are essential for obtaining accurate medical images; however, their use carries a significant risk of nephrotoxicity, a complication that can lead to acute kidney injury (AKI). This systematic review aims to assess the impact of iodinated and gadolinium-based contrast agents on kidney function, comparing their relative risk of inducing contrast-induced nephropathy (CIN). Objectives: To evaluate the impact of radiological contrast agents on renal function. Material and methods: A systematic review of the literature available in databases such as PubMed and Google Scholar were conducted. Observational studies controlled clinical trials, meta-analyses, and systematic reviews published between 2009 and 2024 that evaluated the impact of iodinated and gadolinium-based contrast agents in adult patients undergoing imaging studies were included. Results: The review indicated that the incidence of contrast-induced nephropathy (CIN) varies according to the type of contrast agent and patient conditions. In populations without risk factors, the incidence of CIN was low, while in patients with chronic kidney disease or diabetes, the incidence was significantly higher (up to 12%). No significant differences were observed between iodinated and gadolinium-based contrast agents in terms of CIN risk. In patients with renal insufficiency, proper hydration, combined with other measures such as the use of nitrates, was highlighted as the most effective preventive strategy. There was no clear benefit of N-acetylcysteine in reducing CIN. Overall, intravenous hydration remains the key preventive measure to reduce CIN risk. Conclusion: The literature review indicates the need for more rigorous clinical trials to assess the efficacy and safety of different contrast agents. It highlights the importance of a thorough assessment of individual risk factors to minimize nephrotoxicity in patients undergoing contrast-based procedures.
References
Shams E, Mayrovitz HN. Contrast-Induced Nephropathy: A Review of Mechanisms and Risks [Internet]. Cureus; 2021 May 4 [cited 2024 Oct 4]. Available from: https://www.cureus.com/articles/58401-contrast-induced-nephropathy-a-review-of-mechanisms-and-risks
Mamoulakis C, Tsarouhas K, Fragkiadoulaki I, Heretis I, Wilks MF, Spandidos DA, et al. Contrast-induced nephropathy: Basic concepts, pathophysiological implications and prevention strategies. Pharmacol Ther. 2017 Dec;180:99–112.
Contrast Media Safety Committee. ESUR Guidelines on Contrast Agents, version 10.0. European Society of Urogenital Radiology; 2018.
Gorelik Y, Yaseen H, Heyman SN, Khamaisi M. Negligible risk of acute renal failure among hospitalized patients after contrast-enhanced imaging with iodinated versus gadolinium-based agents. Invest Radiol. 2019 May;54(5):312–8.
McDonald RJ, McDonald JS, Bida JP, Carter RE, Fleming CJ, Misra S, et al. Intravenous contrast material–induced nephropathy. Contrast Media. 2013;267(1).
Qian G, Liu C, Guo J, Dong W, Wang J, Chen Y. Prevention of contrast-induced nephropathy by adequate hydration combined with isosorbide dinitrate for patients with renal insufficiency and congestive heart failure. Clin Cardiol. 2019 Jan;42(1):21–5.
Sun Z, Fu Q, Cao L, Jin W, Cheng L, Li Z. Intravenous N-acetylcysteine for prevention of contrast-induced nephropathy: A meta-analysis of randomized, controlled trials. PLoS One. 2013 Jan 30;8(1):e55124.
Weisbord SD, Palevsky PM, Kaufman JS, Wu H, Androsenko M, Ferguson RE, et al. Contrast-associated acute kidney injury and serious adverse outcomes following angiography. J Am Coll Cardiol. 2020 Mar;75(11):1311–20.
Cheungpasitporn W, Thongprayoon C, Brabec B, Edmonds P, O′Corragain O, Erickson S. Oral hydration for prevention of contrast-induced acute kidney injury in elective radiological procedures: A systematic review and meta-analysis of randomized controlled trials. N Am J Med Sci. 2014;6(12):618.
Lee T, Kim WK, Kim AJ, Ro H, Chang JH, Lee HH, et al. Low-osmolar vs. iso-osmolar contrast media on the risk of contrast-induced acute kidney injury: A propensity score matched study. Front Med. 2022 Apr 29;9:862023.
Everson M, Sukcharoen K, Milner Q. Contrast-associated acute kidney injury. BJA Educ. 2020 Dec;20(12):417–23.
Van Der Molen AJ, Dekkers IA, Bedioune I, Darmon-Kern E. A systematic review of the incidence of hypersensitivity reactions and post-contrast acute kidney injury after ioversol in more than 57,000 patients: part 1—intravenous administration. Eur Radiol. 2022 Mar 21;32(8):5532–45.
Ehrmann S, Quartin A, Hobbs BP, Robert-Edan V, Cely C, Bell C, et al. Contrast-associated acute kidney injury in the critically ill: systematic review and Bayesian meta-analysis. Intensive Care Med. 2017 Jun;43(6):785–94.
Weinreb JC, Rodby RA, Yee J, Wang CL, Fine D, McDonald RJ, et al. Use of intravenous gadolinium-based contrast media in patients with kidney disease: Consensus statements from the American College of Radiology and the National Kidney Foundation. Radiology. 2021 Jan;298(1):28–35.
Honda T, Kuriyama K, Kiso K, Kishimoto K, Tsuboyama T, Inoue A, et al. Incidence rate of severe adverse drug reactions to nonionic contrast media at the National Hospital Organization Osaka National Hospital. Allergo J Int. 2020 Nov;29(7):240–4.
Cha MJ, Kang DY, Lee W, Yoon SH, Choi YH, Byun JS, et al. Hypersensitivity reactions to iodinated contrast media: A multicenter study of 196,081 patients. Radiology. 2019 Oct;293(1):117–24.
Gomi T, Nagamoto M, Hasegawa M, Katoh A, Sugiyama M, Murata N, et al. Are there any differences in acute adverse reactions among five low-osmolar non-ionic iodinated contrast media? Eur Radiol. 2010 Jul;20(7):1631–5.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Aline Aparecida Pacheco, Analía Claudia Sabattini (Author)
This work is licensed under a Creative Commons Attribution 4.0 International License.
The article is distributed under the Creative Commons Attribution 4.0 License. Unless otherwise stated, associated published material is distributed under the same licence.
How to Cite
