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This Article Figures Only Full Text Full Text (PDF) View Previously Unpublished Trials Included in the Meta-Analysis All Versions of this Article: j.jacc.2006.02.073v1 48/4/692    most recent Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (35) Citing Articles via Google Scholar Google Scholar Articles by McCullough, P. A. Articles by Stacul, F. Search for Related Content PubMed PubMed Citation Articles by McCullough, P. A. Articles by Stacul, F.

CLINICAL RESEARCH: INVASIVE CARDIOLOGY

A Meta-Analysis of the Renal Safety of Isosmolar Iodixanol Compared With Low-Osmolar Contrast Media

Peter A. McCullough, MD, MPH, FACC^_*,_*, Michel E. Bertrand, MD, FACC, Jeffrey A. Brinker, MD, FACC and Fulvio Stacul, MD

^_* Department of Medicine, Divisions of Cardiology and Preventive Medicine, William Beaumont Hospital, Royal Oak, Michigan
Division of Cardiology, The Johns Hopkins Medical Institutions, Baltimore, Maryland
Division of Cardiology, University of Lille, Lille, France
Institute of Radiology, University of Trieste, Trieste, Italy

Manuscript received October 3, 2005; revised manuscript received February 22, 2006, accepted February 28, 2006.

^_* Reprint requests and correspondence: Dr. Peter A. McCullough, Divisions of Cardiology and Preventive Medicine, William Beaumont Hospital, 4949 Coolidge Highway, Royal Oak, Michigan 48073. (Email: pmccullough{at}beaumont.edu).

OBJECTIVES: We sought to compare the nephrotoxicity of isosmolar contrast medium (IOCM) iodixanol with low-osmolar contrast media (LOCM) and to identify predictors of contrast-induced nephropathy (CIN).

BACKGROUND: Contrast-induced nephropathy is a serious complication of diagnostic and interventional procedures.

METHODS: Pooled individual patient data (n = 2,727) from 16 double-blind, randomized, controlled trials in which patients received either intra-arterial IOCM iodixanol (n = 1,382) or LOCM (n = 1,345) were included. Patients were stratified according to chronic kidney disease (CKD), diabetes mellitus (DM), or both. Outcome measures were the maximum increase in serum creatinine (Cr) over baseline and the incidence of postprocedural CIN.

RESULTS: The maximum Cr increase within 3 days after contrast medium (CM) administration was significantly smaller in the iodixanol group compared with the LOCM group (0.06 mg/dl vs. 0.10 mg/dl, p < 0.001), particularly in patients with CKD (0.07 mg/dl vs. 0.16 mg/dl, p = 0.004) and CKD + DM (0.10 mg/dl vs. 0.33 mg/dl, p = 0.003). Contrast-induced nephropathy, defined as an increase in Cr 0.50 mg/dl within 3 days after CM administration, occurred less frequently in the iodixanol group than in the LOCM group in all patients (1.4% vs. 3.5%, p < 0.001), in CKD patients (2.8% vs. 8.4%, p = 0.001), and in CKD + DM patients (3.5% vs. 15.5%, p = 0.003). Independent predictors of CIN included CKD, CKD + DM, and use of LOCM.

CONCLUSIONS: This meta-analysis of pooled data from 2,727 patients indicates that use of the IOCM iodixanol is associated with smaller rises in Cr and lower rates of CIN than LOCM, especially in patients with CKD or CKD + DM.

Abbreviations and Acronyms   CI = confidence interval   CIN = contrast-induced nephropathy   CKD = chronic kidney disease   CM = contrast media   Cr = creatinine   DM = diabetes mellitus   HOCM = high-osmolar contrast media   IOCM = isosmolar contrast media   LOCM = low-osmolar contrast media

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