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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

View larger version (11K): [in a new window]   Figure 1 The proportion of patients with a creatinine measurement available on the days after administration of contrast media (CM). Patients received either isosmolar contrast media (IOCM) (iodixanol) or low-osmolar contrast media (LOCM). Pre-CM = baseline before contrast media was given.

View larger version (12K): [in a new window]   Figure 2 Maximal absolute increase in the creatinine (Cr) concentration from baseline to day 3, after contrast administration. The differences in Cr between the IOCM iodixanol and LOCM groups were compared with the Student t test. Patients received either IOCM or LOCM. CKD = chronic kidney disease; DM = diabetes mellitus; other abbreviations as in Figure 1.

View larger version (28K): [in a new window]   Figure 3 Summary of all trials in which at least 1 subject experienced contrast-induced nephropathy (CIN) defined as a rise in Cr 0.50 mg/dl (10 of 16). The chi-square test for heterogeneity was not significant (p = 0.25), indicating homogenous incidence rates for CIN among these trials. According to this result, the fixed effects model was chosen to test the overall effect. The test for the overall effect showed a significant difference in favor of the group receiving IOCM, with the odds ratio (OR) = 0.39, 95% confidence interval (CI) 0.23 to 0.66, p = 0.0004 (19,20,25,26,30,32–36). Heterogeneity test for trials in which at least 1 patient experienced CIN (10 of 16), and test for the overall effect with trials weighted according to the Mantel-Haenszel method, with the Review Manager 4.2.7. n = number of patients who experienced CIN defined as Cr increase 0.50 mg/dl; N = number of patients with Cr measurements; PTCA = percutaneous transluminal coronary angioplasty (trial [25]); other abbreviations as in Figure 1.