Comparative effect of contrast media type on the incidence of contrast-induced nephropathy a systematic review and meta-analysis

John Eng, Renee F. Wilson, Rathan M. Subramaniam, Allen Zhang, Catalina Suarez-Cuervo, Sharon Turban, Michael J. Choi, Cheryl Sherrod, Susan Hutfless, Emmanuel E. Iyoha, Eric B. Bass

Research output: Contribution to journalReview article

42 Citations (Scopus)

Abstract

Background: Iodine contrast media are essential components of many imaging procedures. An important potential side effect is contrast-induced nephropathy (CIN). Purpose: To compare CIN risk for contrast media within and between osmolality classes in patients receiving diagnostic or therapeutic imaging procedures. Data Sources: PubMed, EMBASE, Cochrane Library, Clinical Trials.gov, and Scopus through June 2015. Study Selection: Randomized, controlled trials that reported CIN-related outcomes in patients receiving low-osmolar contrast media (LOCM) or iso-osmolar contrast media for imaging. Data Extraction: Independent study selection and quality assessment by 2 reviewers and dual extraction of study characteristics and results. Data Synthesis: 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. Limitations: Few studies compared LOCM. Procedural details about contrast administration were not uniformly reported. Few studies specified clinical indications or severity of baseline renal impairment. Conclusion: 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.

Original languageEnglish (US)
Pages (from-to)417-424
Number of pages8
JournalAnnals of Internal Medicine
Volume164
Issue number6
DOIs
StatePublished - Mar 15 2016

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Contrast Media
Meta-Analysis
Incidence
Randomized Controlled Trials
Information Storage and Retrieval
PubMed
Iodine
Osmolar Concentration
Libraries
Clinical Trials
Kidney

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Comparative effect of contrast media type on the incidence of contrast-induced nephropathy a systematic review and meta-analysis. / Eng, John; Wilson, Renee F.; Subramaniam, Rathan M.; Zhang, Allen; Suarez-Cuervo, Catalina; Turban, Sharon; Choi, Michael J.; Sherrod, Cheryl; Hutfless, Susan; Iyoha, Emmanuel E.; Bass, Eric B.

In: Annals of Internal Medicine, Vol. 164, No. 6, 15.03.2016, p. 417-424.

Research output: Contribution to journalReview article

Eng, J, Wilson, RF, Subramaniam, RM, Zhang, A, Suarez-Cuervo, C, Turban, S, Choi, MJ, Sherrod, C, Hutfless, S, Iyoha, EE & Bass, EB 2016, 'Comparative effect of contrast media type on the incidence of contrast-induced nephropathy a systematic review and meta-analysis', Annals of Internal Medicine, vol. 164, no. 6, pp. 417-424. https://doi.org/10.7326/M15-1402
Eng, John ; Wilson, Renee F. ; Subramaniam, Rathan M. ; Zhang, Allen ; Suarez-Cuervo, Catalina ; Turban, Sharon ; Choi, Michael J. ; Sherrod, Cheryl ; Hutfless, Susan ; Iyoha, Emmanuel E. ; Bass, Eric B. / Comparative effect of contrast media type on the incidence of contrast-induced nephropathy a systematic review and meta-analysis. In: Annals of Internal Medicine. 2016 ; Vol. 164, No. 6. pp. 417-424.
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AU - Eng, John

AU - Wilson, Renee F.

AU - Subramaniam, Rathan M.

AU - Zhang, Allen

AU - Suarez-Cuervo, Catalina

AU - Turban, Sharon

AU - Choi, Michael J.

AU - Sherrod, Cheryl

AU - Hutfless, Susan

AU - Iyoha, Emmanuel E.

AU - Bass, Eric B.

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N2 - Background: Iodine contrast media are essential components of many imaging procedures. An important potential side effect is contrast-induced nephropathy (CIN). Purpose: To compare CIN risk for contrast media within and between osmolality classes in patients receiving diagnostic or therapeutic imaging procedures. Data Sources: PubMed, EMBASE, Cochrane Library, Clinical Trials.gov, and Scopus through June 2015. Study Selection: Randomized, controlled trials that reported CIN-related outcomes in patients receiving low-osmolar contrast media (LOCM) or iso-osmolar contrast media for imaging. Data Extraction: Independent study selection and quality assessment by 2 reviewers and dual extraction of study characteristics and results. Data Synthesis: 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. Limitations: Few studies compared LOCM. Procedural details about contrast administration were not uniformly reported. Few studies specified clinical indications or severity of baseline renal impairment. Conclusion: 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.

AB - Background: Iodine contrast media are essential components of many imaging procedures. An important potential side effect is contrast-induced nephropathy (CIN). Purpose: To compare CIN risk for contrast media within and between osmolality classes in patients receiving diagnostic or therapeutic imaging procedures. Data Sources: PubMed, EMBASE, Cochrane Library, Clinical Trials.gov, and Scopus through June 2015. Study Selection: Randomized, controlled trials that reported CIN-related outcomes in patients receiving low-osmolar contrast media (LOCM) or iso-osmolar contrast media for imaging. Data Extraction: Independent study selection and quality assessment by 2 reviewers and dual extraction of study characteristics and results. Data Synthesis: 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. Limitations: Few studies compared LOCM. Procedural details about contrast administration were not uniformly reported. Few studies specified clinical indications or severity of baseline renal impairment. Conclusion: 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.

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