The relative renal safety of iodixanol compared with low-osmolar contrast media: a meta-analysis of randomized controlled trials.
OBJECTIVE
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.
Reed
Michael
M
University of Michigan School of Medicine, VA Ann Arbor Healthcare System, University of Michigan, Ann Arbor, MI 48109-5853, USA.
Meier
Pascal
P
Tamhane
Umesh U
UU
Welch
Kathy B
KB
Moscucci
Mauro
M
Gurm
Hitinder S
HS
D000368:Aged; D000369:Aged, 80 and over; D003257:Consumer Product Safety; D003287:Contrast Media / Q000009:adverse effects*; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D007472:Iohexol / Q000009:adverse effects; D007479:Iopamidol / Q000009:adverse effects; D007485:Ioxaglic Acid / Q000009:adverse effects; D007674:Kidney Diseases / Q000139:chemically induced* / Q000401:mortality / Q000628:therapy; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D009994:Osmolar Concentration; D016032:Randomized Controlled Trials as Topic; D006435:Renal Dialysis; D018570:Risk Assessment; D012307:Risk Factors; D014283:Triiodobenzoic Acids / Q000009:adverse effects*
D003287:Contrast Media; D014283:Triiodobenzoic Acids; D007472:Iohexol; C044834:iodixanol; D007479:Iopamidol; C054871:ioversol; D007485:Ioxaglic Acid