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.
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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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