Effects of Intra-Arterial and Intravenous Iso-Osmolar Contrast Medium (Iodixanol) on the Risk of Contrast-Induced Acute Kidney Injury: A Meta-Analysis

Abstract

Background: The iso-osmolar contrast agent iodixanol may be associated with a lower incidence of contrast-induced acute kidney injury (CI-AKI) than low-osmolar contrast media (LOCM), but previous meta-analyses have yielded mixed results. Objectives: To compare the incidence of CI-AKI between iodixanol and LOCM. Methods: Studies were identified from literature searches to December 2009, clinicaltrials.gov, and conference abstracts from the past 2 years including 2010. Only prospective, randomized comparisons between iodixanol and LOCM with CI-AKI [increase in serum creatinine (sCr) ≧0.5 mg/dl or ≧25% from baseline, as defined in the trial] as a primary and/or secondary endpoint and a Jadad score ≧2 were included. A random-effects model was used to obtain pooled relative risks (RRs) for CI-AKI in analyses based on route of administration [intra-arterial (IA) or intravenous (IV)], definition of CI-AKI, and timing of sCr measurements. Results: 145 potential articles were identified, of which 25 were included in the meta-analysis. Following IA administration (n = 19), the RR for CI-AKI (≧0.5 mg/dl definition) with iodixanol, compared with LOCM, was 0.462 [95% confidence interval (CI): 0.272–0.786, p = 0.004, 15 studies]. Using the ≧25% definition, there was a lower incidence of CI-AKI with iodixanol versus LOCM, but the difference was not statistically significant (RR: 0.577, 95% CI: 0.297–1.12, p = 0.104, 11 studies). In the IV trials, there was no significant difference in the incidence of CI-AKI using either definition (≧0.5 mg/dl definition: RR: 0.967, 95% CI: 0.188–4.972, p = 0.968, 3 trials; ≧25% definition: RR: 0.656, 95% CI: 0.316–1.360, p = 0.257, 4 trials). Conclusions: IA but not IV administration of iodixanol is associated with a significantly lower risk of CI-AKI than LOCM.

Iso-osmolar contrast media and adverse renal and cardiac events after percutaneous cardiovascular intervention

“…The incidence of CI-AKI varies from 2% in the general population to over 50% in high-risk groups [7]. In studies of the impact of the osmolality of iodinated CM, the use of low-osmolar contrast media (LOCM) has been shown to substantially reduce the risk of nephropathy when compared with high-osmolar CM [8][9][10][11].In several studies, iodixanol, iso-osmolar contrast media (IOCM) have been associated with lower risk for CI-AKI when compared with LOCM [12][13][14][15][16]. In a meta-analysis of 16 randomized controlled trials, McCullough et al found that CI-AKI occurred less frequently for all patients in the iodixanol group when compared with the LOCM group [15].…”

“…In several studies, iodixanol, iso-osmolar contrast media (IOCM) have been associated with lower risk for CI-AKI when compared with LOCM [12][13][14][15][16]. In a meta-analysis of 16 randomized controlled trials, McCullough et al found that CI-AKI occurred less frequently for all patients in the iodixanol group when compared with the LOCM group [15].…”

Reducing Acute Kidney Injury Due to Contrast Material: How Nurses Can Improve Patient Safety

“…This type of agent has been associated with a lower incidence of CI-AKI in patients with high risk for the renal injury: patients who have a history of diabetes, CKD, or reduced eGFR. 25 However, our top-performing centers use a low-osmolar contrast agent and maintain a low CI-AKI rate.…”

“…11 During this time, the prolonged exposure of the renal tubules to the contrast agent propagates direct cellular injury, inducing tubular apoptosis ( Figure 1). 12 Measures to prevent CI-AKI have been studied, including the use of physiological saline for volume expansion, 13 intravenous versus oral volume expansion, [14][15][16][17][18][19] physiological saline versus sodium bicarbonate intravenous prophylaxis, 20 use of medications such as N-acetylcysteine [21][22][23] and ascorbic acid, 24 withholding nephrotoxic medications before the procedure with contrast material and after the dose of contrast material is administered, 3 type of contrast medium used, 25 use of volumes of contrast material based on initial estimated glomerular filtration rate (eGFR), [26][27][28] and postprocedure hydration. Such studies indicated the following: Use of physiological saline alone protected better against renal insufficiency than did physiological saline with mannitol or furosemide.…”

“…Intra-arterial administration of isoosmolar contrast medium, but not intravenous administration, was associated with lower risk for CI-AKI than was administration of low-osmolar contrast medium. 25 Incremental increases in the volume of contrast medium exceeding the safe contrast limit were associated with a higher risk for contrast-induced nephropathy. 26,27 These studies were performed primarily by physicians and researchers; the study by Solomon et al 13 was the only investigation in which one of the authors was a nurse.…”