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Submitted: 16 Sep 2025
Revision: 25 Oct 2025
Accepted: 10 Dec 2025
ePublished: 18 Dec 2025
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J Renal Inj Prev. 2026;15(1): e38399.
doi: 10.34172/jrip.2025.38399

Meta-analysis

C-reactive protein to albumin ratio as a predictor of contrast-induced nephropathy; a systematic review and meta-analysis

Sam Mirfendereski 1 ORCID logo, Mahdieh Ahmadnia 2 ORCID logo, Ali Hasanpour Dehkordi 3* ORCID logo

1 Department of Radiology, Isfahan University of Medical Sciences, Isfahan, Iran
2 General Medicine Register, Redland Hospital, Brisbane, Queensland, Australia
3 Community-Oriented Nursing Midwifery Research Center, Nursing and Midwifery School, Shahrekord University of Medical Sciences, Shahrekord, Iran
*Corresponding Author: Ali Hasanpour Dehkordi, Email: alihassanpourdehkordi@gmail.com

Abstract

Introduction: The C-reactive protein-to-albumin ratio (CAR) is a marker of inflammation that has been found to be more informative in assessing inflammation conditions in cardiovascular patients than the C-reactive protein (CRP) or albumin (ALB) levels only. Since inflammation has been identified as a factor causing contrast-induced nephropathy (CIN), this research seeks to establish the correlation between the CAR and the risk of CIN.

Materials and Methods: This systematic review and meta-analysis was conducted according to the PRISMA protocol. The Cochrane, PubMed, ProQuest, and Web of Science databases, as well as the Google Scholar search engine, were searched with no time limit up to August 8, 2024. Data were analyzed using STATA 14 software at a significance level of P < 0.05 for all tests.

Results: The findings of five reviewed studies with a total number of 1,442 participants showed a statistically significant positive correlation between CAR (OR: 2.11, 95% CI: 1.41, 3.14) and CRP (OR: 1.11, 95% CI: 1.02, 1.20), with an increase in the risk of CIN. However, no statistically significant associations were found between the patient age (OR: 1.02, 95% CI: 0.96, 1.09), albumin level (OR: 0.64, 95% CI: 0.14, 2.90), hypertension (OR: 2.12, 95% CI: 0.86, 5.21), and diabetes mellitus (OR: 0.80, 95% CI: 0.28, 2.29) variables and the risk of CIN.

Conclusion: Elevated CAR and CRP are CIN risk factors that can be evaluated to provide a good prognosis of this condition. Nevertheless, albumin levels were not significantly related to the development of CIN.

Registration: This study has been compiled based on the PRISMA checklist, and its protocol was registered on the PROSPERO (ID: CRD42024580053) and Research Registry (UIN: reviewregistry1874) websites.



Implication for health policy/practice/research/medical education:

In this meta-analysis we found that C-reactive protein-to-albumin ratio (CAR) and C-reactive protein (CRP) are proteins that raise contrast-induced nephropathy (CIN risk), therefore, their value can be conducted to diagnose the condition. However, the correlation between the albumin levels and the incidence of CIN was not statistically significant. Consequently, increased levels of CAR and consequently can be regarded as significant risk factors for contrast-induced acute kidney injury prediction in patients with type 2 diabetes. Specifically, CAR levels are elevated in patients with contrast-induced acute kidney injury than in those with CRP only, suggesting that CAR is a serious risk factor for CIN.

Please cite this paper as: Mirfendereski S, Ahmadnia M, Hasanpour Dehkordi A. C-reactive protein to albumin ratio as a predictor of contrast-induced nephropathy; a systematic review and meta-analysis. J Renal Inj Prev. 2026; 15(1): e38399. doi: 10.34172/jrip.2025.38399.

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