Nephrotoxicity of Iso-osmolar Iodixanol Compared with Nonionic Low-osmolar Contrast Media: Meta-analysis of Randomized Controlled Trials

Abstract

Iodixanol is not associated with a significantly reduced risk of CIN compared with the LOCM pooled together. However, in patients with intraarterial administration and renal insufficiency, iodixanol is associated with a reduced risk of CIN compared with iohexol, whereas no significant difference between iodixanol and other LOCM could be found.

2009 Focused Updates: ACC/AHA Guidelines for the Management of Patients With ST‐Elevation Myocardial Infarction (Updating the 2004 Guideline and 2007 Focused Update) and ACC/AHA/SCAI Guidelines on Percutaneous Coronary Intervention (Updating the 2005 Guideline and 2007 Focused Update)

“…19 Since then, several larger randomized trials have been published that reported no difference in CIN when iodixanol was compared with various other low-osmolar contrast media (LOCM). 19,[121][122][123] 124,125 ), but no difference was noted in comparisons of iodixanol with iopamidol, iopromide, or ioversal, 124 and a single trial favored iomeprol. 123 A pooled comparison of iodixanol with all nonionic LOCM other than iohexol indicated equivalent safety (RR 0.97; CI 0.72 to 1.32, P¼ 0.86 125 ).…”

“…19,[121][122][123] 124,125 ), but no difference was noted in comparisons of iodixanol with iopamidol, iopromide, or ioversal, 124 and a single trial favored iomeprol. 123 A pooled comparison of iodixanol with all nonionic LOCM other than iohexol indicated equivalent safety (RR 0.97; CI 0.72 to 1.32, P¼ 0.86 125 ). Results were consistent regardless of ancillary preventive therapies (hydration, acetylcysteine), route of administration (intravenous or intra-arterial), age, sex, dose, or preexisting CKD or diabetes.…”

Guidelines on the use of iodinated contrast media in patients with kidney disease 2012: digest version

“…However, in a multicenter, randomized, double-blind comparison of the low-osmolar contrast medium (iopamidol) and the isoosmolar contrast medium (iodixanol), the incidence of CIN was not statistically different after the intra-arterial administration of iopamidol or iodixanol to high-risk patients [56]. In a meta-analysis of 25 RCTs, iso-osmolar iodixanol did not significantly reduce the risk of CIN (relative risk [RR] 0.80, 95 % CI 0.61-1.04) [57]. However, in patients with intra-arterial administration and kidney dysfunction, the risk of CIN was lower for isoosmolar iodixanol than for low-osmolar iohexol (RR 0.38, 95 % CI 0.21-0.68), whereas there was no difference between iodixanol and the other (non-iohexol) lowosmolar contrast media (RR 0.95, 95 % CI 0.50-1.78).…”

Preventing radiocontrast-induced nephropathy in chronic kidney disease patients undergoing coronary angiography

“…The disparate results of these previous 14 clinical trials led to a proliferation of systematic reviews and meta-analyses comparing the nephrotoxicity of IOCM iodixanol and various LOCM; five of which have now been published [32,[62][63][64][65][66] . Among earlier meta-analyses by McCullough et al [62] , pooled data from 2727 patients from 16 doubleblind, RCTs have indicated that use of the IOCM iodixanol is associated with smaller rises in creatinine and lower rates of RCIN than LOCM (1.4% vs 3.5%, P < 0.001), especially in patients with CKD or CKD and diabetes mellitus.…”