[Contrast-induced nephropathy in patients at risk of renal failure undergoing computed tomography: systematic review and meta-analysis of randomized controlled trials].
OBJECTIVE
We evaluated and quantified by meta-analysis techniques the incidence of contrast-induced nephropathy (CIN) in patients at risk undergoing computed tomography (CT).


METHODS
We conducted a systematic review of randomized controlled clinical trials designated to evaluate the nephrotoxicity related to iso-osmolar contrast media (IOCM) compared to low-osmolar contrast media (LOCM). Main electronic databases searched included PubMed/MEDLINE, EMBASE, ISI Web of Knowledge and Virtual Health Library (BVS-BIREME), as well as abstracts presented at related scientific societies meetings. Prior to data extraction, definitions of nephrotoxicity and risk population were established. Besides meta-analysis, the global agreement between CIN definitions was evaluated with Mantel-Haenszel stratified test.


RESULTS
Five studies were included with 716 randomized patients. When CIN was defined as increased serum creatinine (SCr)>or=25%, the relative risk (RR) was 0.71 (CI95%: 0.40-1.26)-in favor of IOCM-and when it was defined as SCr>or=0.5mg/dL it showed a RR 1.48 (CI95%: 0.37-5.87)-favoring LOCM-in the four studies used this criterion. Mantel-Haenszel stratified test was chi2=2.51 (p=0.8).


CONCLUSIONS
In patients with renal failure undergoing CT there is a similar risk of CIN with the administration of any contrast media studied. CIN incidence depends on the chosen criteria and is lower with the definition of SCr>or=0.5mg/dL at 24-72h. No agreement was found between CIN definitions were adopted.
Arana
Estanislao
E
Fundación Instituto de Investigación en Servicios de Salud, Valencia, Spain. aranae@uv.es
Catalá-López
Ferrán
F
D003287:Contrast Media / Q000009:adverse effects*; D006801:Humans; D007674:Kidney Diseases / Q000139:chemically induced*; D016032:Randomized Controlled Trials as Topic; D051437:Renal Insufficiency / Q000139:chemically induced; D012307:Risk Factors; D014057:Tomography, X-Ray Computed
D003287:Contrast Media