The Relative Renal Safety of Iodixanol Compared With Low-Osmolar Contrast Media. A Meta-Analysis of Randomized Controlled Trials

Michael Reed, Pascal Meier, Umesh U. Tamhane, Kathy B. Welch, Mauro Moscucci, Hitinder S. Gurm

Research output: Contribution to journalArticle

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Abstract

Objectives: We sought to compare the nephrotoxicity of the iso-osmolar contrast medium, iodixanol, to low-osmolar contrast media (LOCM). Background: Contrast-induced acute kidney injury (CI-AKI) is a common cause of in-hospital renal failure. A prior meta-analysis suggested that iodixanol (Visipaque, GE Healthcare, Princeton, New Jersey) was associated with less CI-AKI than LOCM, but this study was limited by ascertainment bias and did not include the most recent randomized controlled trials. Methods: We searched Medline, Embase, ISI Web of Knowledge, Google Scholar, Current Contents, and International Pharmaceutical Abstracts databases, and the Cochrane Central Register of Controlled Trials from 1980 to November 30, 2008, for randomized controlled trials that compared the incidence of CI-AKI with either iodixanol or LOCM. Random-effects models were used to calculate summary risk ratios (RR) for CI-AKI, need for hemodialysis, and death. Results: A total of 16 trials including 2,763 subjects were pooled. There was no significant difference in the incidence of CI-AKI in the iodixanol group than in the LOCM group overall (summary RR: 0.79, 95% confidence interval [CI]: 0.56 to 1.12, p = 0.19). There was no significant difference in the rates of post-procedure hemodialysis or death. There was a reduction in CI-AKI when iodixanol was compared with ioxaglate (RR: 0.58, 95% CI: 0.37 to 0.92; p = 0.022) and iohexol (RR: 0.19, 95% CI: 0.07 to 0.56; p = 0.002), but no difference when compared with iopamidol (RR: 1.20, 95% CI: 0.66 to 2.18; p = 0.55), iopromide (RR: 0.93, 95% CI: 0.47 to 1.85; p = 0.84), or ioversol (RR: 0.92, 95% CI: 0.60 to 1.39; p = 0.68). Conclusions: This meta-analysis including 2,763 subjects suggests that iodixanol, when compared with LOCM overall, is not associated with less CI-AKI. The relative renal safety of LOCM compared with iodixanol may vary based on the specific type of LOCM.

Original languageEnglish
Pages (from-to)645-654
Number of pages10
JournalJACC: Cardiovascular Interventions
Volume2
Issue number7
DOIs
StatePublished - Jul 1 2009

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Contrast Media
Meta-Analysis
Acute Kidney Injury
Randomized Controlled Trials
Kidney
Safety
Odds Ratio
Confidence Intervals
ioversol
iopromide
Renal Dialysis
Ioxaglic Acid
Iopamidol
Pharmaceutical Databases
Iohexol
iodixanol
Incidence
Renal Insufficiency
Delivery of Health Care

Keywords

  • contrast media
  • contrast-induced acute kidney injury
  • contrast-induced nephropathy
  • iodixanol
  • low-osmolar contrast media
  • meta-analysis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

The Relative Renal Safety of Iodixanol Compared With Low-Osmolar Contrast Media. A Meta-Analysis of Randomized Controlled Trials. / Reed, Michael; Meier, Pascal; Tamhane, Umesh U.; Welch, Kathy B.; Moscucci, Mauro; Gurm, Hitinder S.

In: JACC: Cardiovascular Interventions, Vol. 2, No. 7, 01.07.2009, p. 645-654.

Research output: Contribution to journalArticle

Reed, Michael ; Meier, Pascal ; Tamhane, Umesh U. ; Welch, Kathy B. ; Moscucci, Mauro ; Gurm, Hitinder S. / The Relative Renal Safety of Iodixanol Compared With Low-Osmolar Contrast Media. A Meta-Analysis of Randomized Controlled Trials. In: JACC: Cardiovascular Interventions. 2009 ; Vol. 2, No. 7. pp. 645-654.
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abstract = "Objectives: We sought to compare the nephrotoxicity of the iso-osmolar contrast medium, iodixanol, to low-osmolar contrast media (LOCM). Background: Contrast-induced acute kidney injury (CI-AKI) is a common cause of in-hospital renal failure. A prior meta-analysis suggested that iodixanol (Visipaque, GE Healthcare, Princeton, New Jersey) was associated with less CI-AKI than LOCM, but this study was limited by ascertainment bias and did not include the most recent randomized controlled trials. Methods: We searched Medline, Embase, ISI Web of Knowledge, Google Scholar, Current Contents, and International Pharmaceutical Abstracts databases, and the Cochrane Central Register of Controlled Trials from 1980 to November 30, 2008, for randomized controlled trials that compared the incidence of CI-AKI with either iodixanol or LOCM. Random-effects models were used to calculate summary risk ratios (RR) for CI-AKI, need for hemodialysis, and death. Results: A total of 16 trials including 2,763 subjects were pooled. There was no significant difference in the incidence of CI-AKI in the iodixanol group than in the LOCM group overall (summary RR: 0.79, 95{\%} confidence interval [CI]: 0.56 to 1.12, p = 0.19). There was no significant difference in the rates of post-procedure hemodialysis or death. There was a reduction in CI-AKI when iodixanol was compared with ioxaglate (RR: 0.58, 95{\%} CI: 0.37 to 0.92; p = 0.022) and iohexol (RR: 0.19, 95{\%} CI: 0.07 to 0.56; p = 0.002), but no difference when compared with iopamidol (RR: 1.20, 95{\%} CI: 0.66 to 2.18; p = 0.55), iopromide (RR: 0.93, 95{\%} CI: 0.47 to 1.85; p = 0.84), or ioversol (RR: 0.92, 95{\%} CI: 0.60 to 1.39; p = 0.68). Conclusions: This meta-analysis including 2,763 subjects suggests that iodixanol, when compared with LOCM overall, is not associated with less CI-AKI. The relative renal safety of LOCM compared with iodixanol may vary based on the specific type of LOCM.",
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AU - Meier, Pascal

AU - Tamhane, Umesh U.

AU - Welch, Kathy B.

AU - Moscucci, Mauro

AU - Gurm, Hitinder S.

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N2 - Objectives: We sought to compare the nephrotoxicity of the iso-osmolar contrast medium, iodixanol, to low-osmolar contrast media (LOCM). Background: Contrast-induced acute kidney injury (CI-AKI) is a common cause of in-hospital renal failure. A prior meta-analysis suggested that iodixanol (Visipaque, GE Healthcare, Princeton, New Jersey) was associated with less CI-AKI than LOCM, but this study was limited by ascertainment bias and did not include the most recent randomized controlled trials. Methods: We searched Medline, Embase, ISI Web of Knowledge, Google Scholar, Current Contents, and International Pharmaceutical Abstracts databases, and the Cochrane Central Register of Controlled Trials from 1980 to November 30, 2008, for randomized controlled trials that compared the incidence of CI-AKI with either iodixanol or LOCM. Random-effects models were used to calculate summary risk ratios (RR) for CI-AKI, need for hemodialysis, and death. Results: A total of 16 trials including 2,763 subjects were pooled. There was no significant difference in the incidence of CI-AKI in the iodixanol group than in the LOCM group overall (summary RR: 0.79, 95% confidence interval [CI]: 0.56 to 1.12, p = 0.19). There was no significant difference in the rates of post-procedure hemodialysis or death. There was a reduction in CI-AKI when iodixanol was compared with ioxaglate (RR: 0.58, 95% CI: 0.37 to 0.92; p = 0.022) and iohexol (RR: 0.19, 95% CI: 0.07 to 0.56; p = 0.002), but no difference when compared with iopamidol (RR: 1.20, 95% CI: 0.66 to 2.18; p = 0.55), iopromide (RR: 0.93, 95% CI: 0.47 to 1.85; p = 0.84), or ioversol (RR: 0.92, 95% CI: 0.60 to 1.39; p = 0.68). Conclusions: This meta-analysis including 2,763 subjects suggests that iodixanol, when compared with LOCM overall, is not associated with less CI-AKI. The relative renal safety of LOCM compared with iodixanol may vary based on the specific type of LOCM.

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