A systematic review of the incidence of hypersensitivity reactions and post-contrast acute kidney injury after ioversol: part 2—intra-arterial administration

Abstract

Objectives To evaluate the incidence of adverse drug reactions (ADRs), including hypersensitivity reactions (HSRs) and post-contrast acute kidney injury (PC-AKI), after intra-arterial (IA) administration of ioversol. Methods and materials A systematic literature search was performed (1980–2021) and studies documenting IA use of ioversol, and reporting safety outcomes were selected. Key information on study design, patients’ characteristics, indication, dose, and type of safety outcome were extracted. Results Twenty-eight studies (including two pediatric studies) with 8373 patients exposed to IA ioversol were selected. Studies were highly heterogenous in terms of design, PC-AKI definition, and studied population. PC-AKI incidence after coronary angiography was 7.5–21.9% in a general population, 4.0-26.4% in diabetic patients, and 5.5–28.9% in patients with chronic kidney disease (CKD). PC-AKI requiring dialysis was rare and reported mainly in patients with severe CKD. No significant differences in PC-AKI rates were shown in studies comparing different iodinated contrast media (ICM). Based on seven studies of ioversol clinical development, the overall ADR incidence was 1.6%, comparable to that reported with other non-ionic ICM. Pediatric data were scarce with only one study reporting on PC-AKI incidence (12%), and one reporting on ADR incidence (0.09%), both after coronary angiography. Conclusions After ioversol IA administration, PC-AKI incidence was highly variable between studies, likely reflecting the heterogeneity of the included study populations, and appeared comparable to that reported with other ICM. The rate of other ADRs appears to be low. Well-designed studies are needed for a better comparison with other ICM. Key Points • PC-AKI incidence after IA administration of ioversol appears to be comparable to that of other ICM, despite the high variability between studies. • The need for dialysis after IA administration of ioversol is rare. • No obvious difference was found regarding the safety profile of ioversol between IA and IV administration.

Elevated Serum Uric Acid/Albumin Ratio as a Predictor of Post-Contrast Acute Kidney Injury After Percutaneous Coronary Intervention in Patients with ST-Segment Elevation Myocardial Infarction

“… 1 The incidence of PC-AKI in the general population after coronary angiography is estimated to be 7.5%–21.9%, and higher in patients with ST elevation myocardial infarction (STEMI) undergoing primary PCI. 2 , 3 Owing to the complexity of the mechanisms, effective preventative or therapeutic measures for PC-AKI are still lacking. 4 , 5 Therefore, the ability to estimate the risk of developing PC-AKI after PCI in a patient with STEMI may have great clinical importance in reducing the incidence of PC-AKI.…”

Risk Factors and Outcome of Acute Kidney Injury following Acute Myocardial Infarction—A Case Series Study from 2009 to 2019

“…Among them, the contrast medium is commonly used in PCIs, which becomes popular in modern cardiology practice. The incidence of AKI after intra-arterial contrast medium injection was 4.0–28.9%, which is highly variable among different patient groups such as the general population and patients with diabetes or chronic kidney disease [ 10 , 11 ]. In a study focus on STEMI patients, Silvain et al demonstrated that one-year patient mortality was independently predicted by hemodynamic instability, cardiac arrest, preexisting renal failure, elderly age, and a high contrast medium volume.…”