title: Comparative Effect of Contrast Media Type on the Incidence of Contrast-Induced Nephropathy: A Systematic Review and Meta-analysis.
abstract: BACKGROUND
  Iodine contrast media are essential components of many imaging procedures. An important potential side effect is contrast-induced nephropathy (CIN).
  
  
  OBJECTIVE
  To compare CIN risk for contrast media within and between osmolality classes in patients receiving diagnostic or therapeutic imaging procedures.
  
  
  METHODS
  PubMed, EMBASE, Cochrane Library, Clinical Trials.gov, and Scopus through June 2015.
  
  
  METHODS
  Randomized, controlled trials that reported CIN-related outcomes in patients receiving low-osmolar contrast media (LOCM) or iso-osmolar contrast media for imaging.
  
  
  METHODS
  Independent study selection and quality assessment by 2 reviewers and dual extraction of study characteristics and results.
  
  
  RESULTS
  None of the 5 studies that compared types of LOCM reported a statistically significant or clinically important difference among study groups, but the strength of evidence was low. Twenty-five randomized, controlled trials found a slight reduction in CIN risk with the iso-osmolar contrast media agent iodixanol compared with a diverse group of LOCM that just reached statistical significance in a meta-analysis (pooled relative risk, 0.80 [95% CI, 0.65 to 0.99]; P = 0.045). This comparison's strength of evidence was moderate. In a meta regression of randomized, controlled trials of iodixanol, no relationship was found between route of administration and comparative CIN risk.
  
  
  CONCLUSIONS
  Few studies compared LOCM. Procedural details about contrast administration were not uniformly reported. Few studies specified clinical indications or severity of baseline renal impairment.
  
  
  CONCLUSIONS
  No differences were found in CIN risk among types of LOCM. Iodixanol had a slightly lower risk for CIN than LOCM, but the lower risk did not exceed a criterion for clinical importance.
  
  
  BACKGROUND
  Agency for Healthcare Research and Quality.
authors.forename: John
authors.initials: J
authors.lastname: Eng
authors.forename: Renee F
authors.initials: RF
authors.lastname: Wilson
authors.forename: Rathan M
authors.initials: RM
authors.lastname: Subramaniam
authors.forename: Allen
authors.initials: A
authors.lastname: Zhang
authors.forename: Catalina
authors.initials: C
authors.lastname: Suarez-Cuervo
authors.forename: Sharon
authors.initials: S
authors.lastname: Turban
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Choi
authors.forename: Cheryl
authors.initials: C
authors.lastname: Sherrod
authors.forename: Susan
authors.initials: S
authors.lastname: Hutfless
authors.forename: Emmanuel E
authors.initials: EE
authors.lastname: Iyoha
authors.forename: Eric B
authors.initials: EB
authors.lastname: Bass
mesh_terms: D003287:Contrast Media / Q000009:adverse effects*; D019317:Evidence-Based Medicine; D006801:Humans; D015994:Incidence; D007674:Kidney Diseases / Q000139:chemically induced* / Q000453:epidemiology*; D009994:Osmolar Concentration; D012307:Risk Factors; D014283:Triiodobenzoic Acids / Q000009:adverse effects
chemical_list: D003287:Contrast Media; D014283:Triiodobenzoic Acids; C044834:iodixanol