TY - JOUR
T1 - Nephropathy after administration of iso-osmolar and low-osmolar contrast media
T2 - evidence from a network meta-analysis
AU - Biondi-Zoccai, Giuseppe
AU - Lotrionte, Marzia
AU - Thomsen, Henrik S
AU - Romagnoli, Enrico
AU - D'Ascenzo, Fabrizio
AU - Giordano, Arturo
AU - Frati, Giacomo
N1 - Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
PY - 2014/3/15
Y1 - 2014/3/15
N2 - Background/objectives Contrast-induced nephropathy (CIN) may be a severe complication to the administration of iodine-based contrast media for diagnostic or interventional procedure using radiation exposure. Whether there is a difference in nephrotoxic potential between the various agents is uncertain. We aimed to perform a systematic review and network meta-analysis of randomized trials on iodine-based contrast agents. Methods Randomized trials of low-osmolar or iso-osmolar contrast media were searched in CENTRAL, Google Scholar, MEDLINE/PubMed, and Scopus. Risk of CIN was appraised within a hierarchical Bayesian model computing absolute rates (AR) and odds ratios (OR) with 95% credibility intervals, and probability of being best (Pbest) for each agent. Results A total of 42 trials (10048 patients) were included focusing on 7 different iodine-based contrast media. Risk of CIN was similarly low with iodixanol (AR = 5.7% [2.2%-13.9%], Pbest = 18.8%), iomeprol (AR = 6.0% [2.2%-15.4%], Pbest = 24.8%), iopamidol (AR = 6.1% [2.2%-15.5%], Pbest = 21.5%), and ioversol (AR = 6.0% [2.1%-16.4%], Pbest = 31.3%). Conversely, CIN was twice as common with iohexol (AR = 11.2% [4.1%-29.5%], Pbest = 0.1%) and ioxaglate (AR = 11.0% [4.0%-26.9%], Pbest < 0.1%), with both proving less safe than iodixanol (respectively OR = 2.18 [1.22-3.92] and 2.05 [1.26-3.29]), iomeprol (OR = 2.08 [1.04-4.17] and 1.96 [1.06-3.48]) and iopamidol (OR = 2.04 [1.15-3.85] and 1.92 [1.06-3.45]). Data on iopromide were less conclusive (AR = 6.9% [2.6%-17.1%], Pbest = 3.6%). Conclusions Iodixanol, iomeprol, iopamidol and ioversol are iodine-based contrast media with a similar renal safety profile. Iohexol and ioxaglate have a poorer renal safety profile, whereas further data may be required on iopromide.
AB - Background/objectives Contrast-induced nephropathy (CIN) may be a severe complication to the administration of iodine-based contrast media for diagnostic or interventional procedure using radiation exposure. Whether there is a difference in nephrotoxic potential between the various agents is uncertain. We aimed to perform a systematic review and network meta-analysis of randomized trials on iodine-based contrast agents. Methods Randomized trials of low-osmolar or iso-osmolar contrast media were searched in CENTRAL, Google Scholar, MEDLINE/PubMed, and Scopus. Risk of CIN was appraised within a hierarchical Bayesian model computing absolute rates (AR) and odds ratios (OR) with 95% credibility intervals, and probability of being best (Pbest) for each agent. Results A total of 42 trials (10048 patients) were included focusing on 7 different iodine-based contrast media. Risk of CIN was similarly low with iodixanol (AR = 5.7% [2.2%-13.9%], Pbest = 18.8%), iomeprol (AR = 6.0% [2.2%-15.4%], Pbest = 24.8%), iopamidol (AR = 6.1% [2.2%-15.5%], Pbest = 21.5%), and ioversol (AR = 6.0% [2.1%-16.4%], Pbest = 31.3%). Conversely, CIN was twice as common with iohexol (AR = 11.2% [4.1%-29.5%], Pbest = 0.1%) and ioxaglate (AR = 11.0% [4.0%-26.9%], Pbest < 0.1%), with both proving less safe than iodixanol (respectively OR = 2.18 [1.22-3.92] and 2.05 [1.26-3.29]), iomeprol (OR = 2.08 [1.04-4.17] and 1.96 [1.06-3.48]) and iopamidol (OR = 2.04 [1.15-3.85] and 1.92 [1.06-3.45]). Data on iopromide were less conclusive (AR = 6.9% [2.6%-17.1%], Pbest = 3.6%). Conclusions Iodixanol, iomeprol, iopamidol and ioversol are iodine-based contrast media with a similar renal safety profile. Iohexol and ioxaglate have a poorer renal safety profile, whereas further data may be required on iopromide.
KW - Bayes Theorem
KW - Contrast Media
KW - Humans
KW - Kidney Diseases
KW - Osmolar Concentration
KW - Randomized Controlled Trials as Topic
KW - Triiodobenzoic Acids
U2 - 10.1016/j.ijcard.2014.01.075
DO - 10.1016/j.ijcard.2014.01.075
M3 - Journal article
C2 - 24502883
SN - 0167-5273
VL - 172
SP - 375
EP - 380
JO - International Journal of Cardiology
JF - International Journal of Cardiology
IS - 2
ER -