title: Contrast media use in patients with chronic kidney disease undergoing coronary angiography: A systematic review and meta-analysis of randomized trials.
abstract: Patients with chronic kidney disease (CKD) undergoing coronary angiography (CA), adequate hydration and minimizing volume of contrast media (CM) are class 1b recommendations for preventing contrast induced nephropathy (CIN). Current data are insufficient to justify specific recommendations about isoosmolar vs. low-osmolar contrast media by the ACCF/AHA/SCAI guidelines.
  
  
  
  Randomized trials comparing IOCM to LOCM in CKD stage 3 and above patients undergoing CA, and reporting incidence of CIN (defined by a rise in creatinine of 25% from baseline) were included in the analysis. The secondary outcome of the study was the incidence of serum creatinine increase by >1mg/dl.
  
  
  
  A total of 2839 patients were included in 10 trials, in which 1430 patients received IOCM and 1393 received LOCM. When compared to LOCM, IOCM was not associated with significant benefit in preventing CIN (OR=0.72, [CI: 0.50-1.04], P=0.08, I2=59%). Subgroup analysis revealed non-significant difference in incidence of CIN based on baseline use of N-acetylcystine (NAC), diabetes status, ejection fraction, and whether percutaneous coronary intervention vs coronary angiography alone was performed. The difference between IOCM and LOCM was further attenuated when restricted to studies with larger sample size (>250 patients) (OR=0.93; [CI: 0.66-1.30]) or when compared with non-ionic LOCM (OR=0.79, [CI: 0.52-1.21]).
  
  
  
  In patients with CKD stage 3 and above undergoing coronary angiography, use of IOCM showed overall non-significant difference in incidence of CIN compared to LOCM. The difference was further attenuated when IOCM was compared with non-ionic LOCM.
authors.affiliation: Department of Internal Medicine, Staten Island University Hospital, United States. Electronic address: dr.bhavipandya@gmail.com.
authors.forename: Bhavi
authors.initials: B
authors.lastname: Pandya
authors.affiliation: Department of Internal Medicine, Staten Island University Hospital, United States.
authors.forename: Jean M
authors.initials: JM
authors.lastname: Chalhoub
authors.affiliation: Department of Cardiology, Staten Island University Hospital, United States.
authors.forename: Valay
authors.initials: V
authors.lastname: Parikh
authors.affiliation: Department of Cardiology, Staten Island University Hospital, United States.
authors.forename: Sainath
authors.initials: S
authors.lastname: Gaddam
authors.affiliation: Department of Internal Medicine, Staten Island University Hospital, United States.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Spagnola
authors.affiliation: Department of Nephrology, Staten Island University Hospital, United States.
authors.forename: Suzanne
authors.initials: S
authors.lastname: El-Sayegh
authors.affiliation: Department of Cardiology, Staten Island University Hospital, United States.
authors.forename: Marc
authors.initials: M
authors.lastname: Bogin
authors.affiliation: Department of Cardiology, Staten Island University Hospital, United States.
authors.forename: Ruben
authors.initials: R
authors.lastname: Kandov
authors.affiliation: Department of Cardiology, Staten Island University Hospital, United States.
authors.forename: James
authors.initials: J
authors.lastname: Lafferty
authors.affiliation: Department of Cardiology, New York University School of Medicine, United States.
authors.forename: Sripal
authors.initials: S
authors.lastname: Bangalore
mesh_terms: D003287:Contrast Media / Q000145:classification / Q000494:pharmacology; D017023:Coronary Angiography / Q000009:adverse effects* / Q000379:methods; D003327:Coronary Disease / Q000150:complications / Q000175:diagnosis; D006801:Humans; D007674:Kidney Diseases / Q000139:chemically induced / Q000517:prevention & control; D007677:Kidney Function Tests; D011315:Preventive Medicine / Q000379:methods*; D051436:Renal Insufficiency, Chronic / Q000150:complications*
chemical_list: D003287:Contrast Media
keywords: Chronic kidney disease; Contrast induced nephropathy; Contrast media; Coronary angiography