Comparison of route and location of contrast delivery on contrast-induced nephropathy: A systematic review and pairwise meta-analysis.

Authors

Muhammad Sabih Saleem, Dipen Zalavadia, Tejas M Patel, Samir B Pancholy

Published in

Cardiovascular revascularization medicine : including molecular interventions. Jul 15, 2026. Epub Jul 15, 2026.

Abstract

Contrast-induced nephropathy (CIN) remains a leading cause of iatrogenic acute kidney injury. Whether the route of contrast administration (intravenous [IV] versus intra-arterial [IA]) and the anatomical level of endovascular manipulation (suprarenal versus infrarenal) independently modify CIN risk is incompletely defined. We hypothesized that direct first-pass exposure of the renal vasculature to contrast and procedure-related embolic stress drive renal injury.
We performed two pairwise random-effects meta-analyses. The first compared CIN incidence after IV versus IA contrast administration across six eligible studies (n = 2961 patients). The second compared CIN incidence after suprarenal versus infrarenal endovascular procedures across fifteen studies (n = 49,838 patients). Pooled odds ratios (ORs) with 95% confidence intervals (CIs) and 95% prediction intervals were calculated using the DerSimonian-Laird estimator.
IV contrast administration was associated with a significantly lower incidence of CIN compared with IA administration (pooled OR 0.63, 95% CI 0.40-0.97; p = 0.036; I² = 48%). Suprarenal endovascular procedures were associated with a significantly higher incidence of CIN than infrarenal procedures (pooled OR 1.27, 95% CI 1.01-1.60; p = 0.043; I² = 43%). Meta-regression showed that differences in weighted mean contrast volume and incidence of diabetes mellitus significantly explained between study heterogeneity.
These findings support the hypothesis that route of contrast delivery and anatomical proximity of endovascular instrumentation to the renal arteries are independent determinants of CIN, supporting the first-pass high concentration exposure and embolic stress as plausible etiologies of renal injury associated with contrast requiring procedures.

PMID:
42521596
Bibliographic data and abstract were imported from PubMed on 29 Jul 2026.

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