Iodixanol versus low-osmolar contrast media for prevention of contrast induced nephropathy meta-analysis of randomized, controlled trials

Aaron M. From, Firas J. Al Badarin, Furman S. McDonald, Brian Jack Bartholmai, Stephen S. Cha, Charanjit S. Rihal

Research output: Contribution to journalArticle

58 Citations (Scopus)

Abstract

Background-Contrast-induced nephropathy (CIN) is associated with significant morbidity and mortality. The objective of our meta-analysis was to assess the efficacy of iodixanol compared with low-osmolar contrast media (LOCM) for prevention of CIN. Methods and Results-We searched MEDLINE, the Cochrane Central Register of Controlled Trials, and internet sources of cardiology trial results for individual and relevant reviews of randomized, controlled trials, for the terms contrast media, contrast nephropathy, renal failure, iodixanol, Visipaque, and low-osmolar contrast media. All studies reported an incidence rate of CIN for each study group; there was no restriction on the definition of CIN. There were no restrictions on journal type or patient population. Overall, 36 trials were identified for analysis of aggregated summary data on 7166 patients; 3672 patients received iodixanol and 3494 patients received LOCM. Overall, iodixanol showed no statistically significant reduction in CIN incidence below that observed with heterogeneous comparator agents (P=0.11). Analysis of patient subgroups revealed that there was a significant benefit of iodixanol when compared with iohexol alone (odds ratio, 0.25; 95% confidence interval, 0.11 to 0.55; P<0.001) but not when compared with LOCM other than iohexol or with other ionic dimers or among patients receiving intra-arterial contrast injections or among patients undergoing coronary angiography with or without percutaneous intervention. Conclusions-Analysis of aggregated summary data from multiple randomized, controlled trials of iodixanol against diverse LOCMs for heterogeneous procedures and definitions of CIN show an iodixanol-associated reduction that is suggestive but statistically nonsignificant.

Original languageEnglish (US)
Pages (from-to)351-358
Number of pages8
JournalCirculation: Cardiovascular Interventions
Volume3
Issue number4
DOIs
StatePublished - Aug 2010

Fingerprint

Contrast Media
Meta-Analysis
Randomized Controlled Trials
Iohexol
Intra-Arterial Injections
iodixanol
Cardiology
Coronary Angiography
MEDLINE
Internet
Renal Insufficiency
Cohort Studies
Odds Ratio
Confidence Intervals
Morbidity
Mortality
Incidence
Population

Keywords

  • Contrast-induced nephropathy
  • Iodixanol
  • Low-osmolar contrast media
  • Visipaque

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Iodixanol versus low-osmolar contrast media for prevention of contrast induced nephropathy meta-analysis of randomized, controlled trials. / From, Aaron M.; Al Badarin, Firas J.; McDonald, Furman S.; Bartholmai, Brian Jack; Cha, Stephen S.; Rihal, Charanjit S.

In: Circulation: Cardiovascular Interventions, Vol. 3, No. 4, 08.2010, p. 351-358.

Research output: Contribution to journalArticle

From, Aaron M. ; Al Badarin, Firas J. ; McDonald, Furman S. ; Bartholmai, Brian Jack ; Cha, Stephen S. ; Rihal, Charanjit S. / Iodixanol versus low-osmolar contrast media for prevention of contrast induced nephropathy meta-analysis of randomized, controlled trials. In: Circulation: Cardiovascular Interventions. 2010 ; Vol. 3, No. 4. pp. 351-358.
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AB - Background-Contrast-induced nephropathy (CIN) is associated with significant morbidity and mortality. The objective of our meta-analysis was to assess the efficacy of iodixanol compared with low-osmolar contrast media (LOCM) for prevention of CIN. Methods and Results-We searched MEDLINE, the Cochrane Central Register of Controlled Trials, and internet sources of cardiology trial results for individual and relevant reviews of randomized, controlled trials, for the terms contrast media, contrast nephropathy, renal failure, iodixanol, Visipaque, and low-osmolar contrast media. All studies reported an incidence rate of CIN for each study group; there was no restriction on the definition of CIN. There were no restrictions on journal type or patient population. Overall, 36 trials were identified for analysis of aggregated summary data on 7166 patients; 3672 patients received iodixanol and 3494 patients received LOCM. Overall, iodixanol showed no statistically significant reduction in CIN incidence below that observed with heterogeneous comparator agents (P=0.11). Analysis of patient subgroups revealed that there was a significant benefit of iodixanol when compared with iohexol alone (odds ratio, 0.25; 95% confidence interval, 0.11 to 0.55; P<0.001) but not when compared with LOCM other than iohexol or with other ionic dimers or among patients receiving intra-arterial contrast injections or among patients undergoing coronary angiography with or without percutaneous intervention. Conclusions-Analysis of aggregated summary data from multiple randomized, controlled trials of iodixanol against diverse LOCMs for heterogeneous procedures and definitions of CIN show an iodixanol-associated reduction that is suggestive but statistically nonsignificant.

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