title: Nephropathy after administration of iso-osmolar and low-osmolar contrast media: evidence from a network meta-analysis.
abstract: OBJECTIVE
  Contrast-induced nephropathy (CIN) may be a severe complication to the administration of iodine-based contrast media for diagnostic or interventional procedure using radiation exposure. Whether there is a difference in nephrotoxic potential between the various agents is uncertain. We aimed to perform a systematic review and network meta-analysis of randomized trials on iodine-based contrast agents.
  
  
  METHODS
  Randomized trials of low-osmolar or iso-osmolar contrast media were searched in CENTRAL, Google Scholar, MEDLINE/PubMed, and Scopus. Risk of CIN was appraised within a hierarchical Bayesian model computing absolute rates (AR) and odds ratios (OR) with 95% credibility intervals, and probability of being best (Pbest) for each agent.
  
  
  RESULTS
  A total of 42 trials (10048 patients) were included focusing on 7 different iodine-based contrast media. Risk of CIN was similarly low with iodixanol (AR=5.7% [2.2%-13.9%], Pbest=18.8%), iomeprol (AR=6.0% [2.2%-15.4%], Pbest=24.8%), iopamidol (AR=6.1% [2.2%-15.5%], Pbest=21.5%), and ioversol (AR=6.0% [2.1%-16.4%], Pbest=31.3%). Conversely, CIN was twice as common with iohexol (AR=11.2% [4.1%-29.5%], Pbest=0.1%) and ioxaglate (AR=11.0% [4.0%-26.9%], Pbest<0.1%), with both proving less safe than iodixanol (respectively OR=2.18 [1.22-3.92] and 2.05 [1.26-3.29]), iomeprol (OR=2.08 [1.04-4.17] and 1.96 [1.06-3.48]) and iopamidol (OR=2.04 [1.15-3.85] and 1.92 [1.06-3.45]). Data on iopromide were less conclusive (AR=6.9% [2.6%-17.1%], Pbest=3.6%).
  
  
  CONCLUSIONS
  Iodixanol, iomeprol, iopamidol and ioversol are iodine-based contrast media with a similar renal safety profile. Iohexol and ioxaglate have a poorer renal safety profile, whereas further data may be required on iopromide.
authors: Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy. Electronic address: giuseppe.biondizoccai@uniroma1.it.
authors: Giuseppe
authors: G
authors: Biondi-Zoccai
authors: Heart Failure and Cardiac Rehabilitation Unit, Columbus Integrated Complex, Rome, Italy.
authors: Marzia
authors: M
authors: Lotrionte
authors: Copenhagen University Hospital, Herlev, Denmark.
authors: Henrik S
authors: HS
authors: Thomsen
authors: Division of Cardiology, Policlinico Casilino, Rome, Italy.
authors: Enrico
authors: E
authors: Romagnoli
authors: Division of Cardiology, University of Turin, Turin, Italy.
authors: Fabrizio
authors: F
authors: D'Ascenzo
authors: Unità Operativa di Interventistica Cardiovascolare, Presidio Ospedaliero Pineta Grande, Castel Volturno, Italy; Unità Operativa di Emodinamica, Casa di Salute Santa Lucia, San Giuseppe Vesuviano, Italy.
authors: Arturo
authors: A
authors: Giordano
authors: Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy.
authors: Giacomo
authors: G
authors: Frati
mesh_terms: D001499:Bayes Theorem; D003287:Contrast Media / Q000009:adverse effects* / Q000737:chemistry; D006801:Humans; D007674:Kidney Diseases / Q000139:chemically induced*; D009994:Osmolar Concentration; D016032:Randomized Controlled Trials as Topic; D014283:Triiodobenzoic Acids / Q000009:adverse effects*
chemical_list: D003287:Contrast Media; D014283:Triiodobenzoic Acids
keywords: Angiography; Contrast-induced nephropathy; Mixed treatment comparison; Network meta-analysis; Systematic review