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

McCullough, Peter A.; Bertrand, Michel E.; Brinker, Jeffrey A.; Stacul, Fulvio

doi:10.1016/j.jacc.2006.02.073

Cited by 309 publications

(222 citation statements)

References 47 publications

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“…A pooled analysis of 16 double-blind, randomized, controlled trials (n ¼ 2,727) comparing nephrotoxicity of iso-smolar contrast medium iodixanol with lowosmolar contrast media was recently published [38]. The maximum creatinine increase within 3 days after contrast medium administration was significantly smaller in the iodixanol group compared with the lowosmolar contrast media group (0.06 mg/dL vs. 0.10 mg/dL; P < 0.001).…”

Section: Type Of Contrast Agentmentioning

confidence: 99%

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Contrast‐induced nephropathy

Pučelíková

Dangas

Mehran

2007

Cathet Cardio Intervent

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Contrast induced nephropathy (CIN) is an iatrogenic disorder, resulting from exposure to contrast media. Contrast-induced hemodynamic and direct cytotoxic effects on renal structures are highly evident in its pathogenesis, whereas other mechanisms are still poorly understood. CIN is typically defined as an increase in serum creatinine by either 0.5 mg/dl or by 25% from baseline within the first 2-3 days after contrast administration. Although rare in the general population, CIN has a high incidence in patients with an underlying renal disorder, in diabetics, and the elderly. The risk factors are synergistic in their ability to produce CIN. The best way to prevent CIN is to identify the patients at risk and to provide adequate peri-procedural hydration. The role of various drugs in prevention of CIN is still controversial and warrants future studies. Despite remaining uncertainty regarding the degree of nephrotoxicity produced by various contrast agents, in current practice non-ionic low-osmolar contrast media are preferred over the high-osmolar contrast media in patients with renal impairment.

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Section: Type Of Contrast Agentmentioning

confidence: 99%

“…Recent data suggests that use of the isoosmolar iodixanol is associated with smaller rises in creatinine and lower rates of CIN than low-osmolar contrast media, especially in patients with renal insufficiency and with combination of renal insufficiency and diabetes mellitus [38,39].…”

Section: Type Of Contrast Agentmentioning

confidence: 99%

Contrast‐induced nephropathy

Pučelíková

Dangas

Mehran

2007

Cathet Cardio Intervent

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“…10 The incidence of nephrotoxicity is less in iso-osmolar non-ionic contrast medium (e.g Iodixanol) than in lowosmolar non-ionic contrast medium (e.g Iopamidol). 11 But one study by Hossain in Bangladesh has shown that no significant difference between iso-osmolar and low-omolar contrast media in patients with chronic kidney disease(CKD). 12 The lowest rate of CIN occurring in patients receiving less than 100 to 140 ml of contrast media.…”

mentioning

confidence: 99%

Impact of Blood Glucose Levels on Contrast Induced Nephropathy after Percutaneous Coronary Intervention in Patients not known to be Diabetic with Acute Coronary Syndrome.

et al. 2013

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Background: Contrast-Induced Nephropathy (CIN) is an iatrogenic disorder, resulting from exposure to contrast media. The association between pre-procedural blood glucose levels and CI-AKI risk (regardless of pre-existing diabetes) is unknown. The present study was conducted to evaluate the incidence of CI-AKI in patients with admission hyperglycemia in non-diabetic ACS patients. Methods: This is Prospective, observational study done in the department of Cardiology, National Institute of Cardiovascular Diseases (NICVD), Dhaka. Considering inclusion and exclusion criteria, 50 patients were non diabetic with ACS with normal blood glucose (d7.8 mmol/l or d140 mg/dl) in (Group I) and 50 patients were non diabetic with ACS with high blood glucose (>7.8 mmol/l or >140 mg/dl) undergoing percutaneous coronary intervention in (Group II). On admission random blood glucose was measured. Non- ionic low osmolar contrast agents (lopamidol) was used in all patients. Serum creatinine, serum electrolytes was measured and creatinine clearance rate was determined within 24 hours before PCI and day 1 and 2 after PCI. Results: The incidence of CIN was 24% in high blood glucose group and 4% in normal blood glucose group (p=0.004). It was also observed that gradual incremental increase in risk of CIN associated with higher admission blood glucose level. There was positive correlation between s. creatinine and admission blood glucose but it showed negative correlation between CCr and admission blood glucose after PCI in ACS patients not known to be diabetic. Conclusion: The present study reveals that index admission high blood glucose in acute coronary syndrome patients not known to be diabetic is associated with increased incidence of contrast induced nephropathy after percutaneous coronary intervention. Cardiovascular Journal Volume 6, No. 1, 2013, Page 23-30 DOI: http://dx.doi.org/10.3329/cardio.v6i1.16111

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“…Intravenous hydration with 0.9% SS) 0.9% SS 1 mL/kg/h, 12 hours before and 12 hours after the procedure Several randomized studies and metaanalyses 30,[32][33][34] 0.9% SS is superior to 0.45% SS 23,32 Sodium bicarbonate (154 mEq/L) NaHCO3 3 mL/kg/h, 1 hour before the procedure and 1 mL/kg/h, 6 hours after the procedure Several randomized studies and meta-analyses 32,[49][50][51][52][53][54] Dilute 154 mL of 8.4% sodium bicarbonate in 846 mL of distilled water for obtaining the solution Type of contrast medium Low-osmolality or iso-osmolality contrast medium Some randomized studies and a few meta-analyses [26][27][28] The literature is still controversial whether isoosmolality contrast medium is superior to low-osmolality contrast medium 29 N-acetyl cysteine 600 mg, orally, 12/12 hours, 24 hours before and after the procedure Still controversial 54,55 Large ongoing multicenter study 56 …”

Section: Most Used Methods Evidence Level Commentsmentioning

confidence: 99%

“…27 McCullough et al have assessed 16 randomized, double-blind studies, in a total of 2,727 patients, and concluded that the use of iso-osmolality contrast medium was better than that of low osmolality contrast medium for preventing CN, mainly in patients with chronic kidney disease and diabetes mellitus. 28 A more recent meta-analysis has compared the use of low-osmolality contrast media with the iso-osmolality contrast medium, iodixanol. It included 16 randomized studies, in a total of 2,763 patients.…”

Section: Osmolalitymentioning

confidence: 99%

Prevenção de nefrotoxicidade por contraste com solução de bicarbonato: resultados preliminares e revisão da literatura

Silva¹,

Silva²,

Lucchesi³

et al. 2010

J. Bras. Nefrol.

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

Abstract: 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.

Cited by 309 publications

References 47 publications

Contrast‐induced nephropathy

Contrast‐induced nephropathy

Impact of Blood Glucose Levels on Contrast Induced Nephropathy after Percutaneous Coronary Intervention in Patients not known to be Diabetic with Acute Coronary Syndrome.

Prevenção de nefrotoxicidade por contraste com solução de bicarbonato: resultados preliminares e revisão da literatura

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