A meta-analysis of the renal safety of isosmolar iodixanol compared with low-osmolar contrast media.
OBJECTIVE
We sought to compare the nephrotoxicity of isosmolar contrast medium (IOCM) iodixanol with low-osmolar contrast media (LOCM) and to identify predictors of contrast-induced nephropathy (CIN).


BACKGROUND
Contrast-induced nephropathy is a serious complication of diagnostic and interventional procedures.


METHODS
Pooled individual patient data (n = 2,727) from 16 double-blind, randomized, controlled trials in which patients received either intra-arterial IOCM iodixanol (n = 1,382) or LOCM (n = 1,345) were included. Patients were stratified according to chronic kidney disease (CKD), diabetes mellitus (DM), or both. Outcome measures were the maximum increase in serum creatinine (Cr) over baseline and the incidence of postprocedural CIN.


RESULTS
The maximum Cr increase within 3 days after contrast medium (CM) administration was significantly smaller in the iodixanol group compared with the LOCM group (0.06 mg/dl vs. 0.10 mg/dl, p < 0.001), particularly in patients with CKD (0.07 mg/dl vs. 0.16 mg/dl, p = 0.004) and CKD + DM (0.10 mg/dl vs. 0.33 mg/dl, p = 0.003). Contrast-induced nephropathy, defined as an increase in Cr > or =0.50 mg/dl within 3 days after CM administration, occurred less frequently in the iodixanol group than in the LOCM group in all patients (1.4% vs. 3.5%, p < 0.001), in CKD patients (2.8% vs. 8.4%, p = 0.001), and in CKD + DM patients (3.5% vs. 15.5%, p = 0.003). Independent predictors of CIN included CKD, CKD + DM, and use of LOCM.


CONCLUSIONS
This meta-analysis of pooled data from 2,727 patients indicates that use of the IOCM iodixanol is associated with smaller rises in Cr and lower rates of CIN than LOCM, especially in patients with CKD or CKD + DM.
McCullough
Peter A
PA
Department of Medicine, Division of Cardiology, William Beaumont Hospital, Royal Oak, Michigan 48073, USA. pmccullough@beaumont.edu
Bertrand
Michel E
ME
Brinker
Jeffrey A
JA
Stacul
Fulvio
F
D003287:Contrast Media / Q000009:adverse effects* / Q000737:chemistry*; D003404:Creatinine / Q000378:metabolism; D003920:Diabetes Mellitus; D006801:Humans; D007674:Kidney Diseases / Q000139:chemically induced* / Q000150:complications / Q000175:diagnosis; D009994:Osmolar Concentration; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D014283:Triiodobenzoic Acids / Q000009:adverse effects*
D003287:Contrast Media; D014283:Triiodobenzoic Acids; D003404:Creatinine; C044834:iodixanol