JACC: Risk of kidney injury equivalent between iso- and low-osmolar contrast media

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Past studies have indicated a benefit regarding the use of an iso-osmolar contrast agent versus low-osmolar contrast media. A new meta-analysis in the July issue of JACC: Cardiovascular Interventions suggests the two types of contrast agents are equivalent in terms of the risk of contrast-induced acute kidney injury (CI-AKI).

CI-AKI is a common cause of in-hospital renal failure. A prior meta-analysis suggested that iodixanol (Visipaque from GE Healthcare) was associated with less CI-AKI than LOCM, but this study was limited by ascertainment bias and did not include the most recent randomized controlled trials, according to the authors of the current study.

The researchers searched a series of databases from 1980 to Nov. 30, 2008, for randomized controlled trials that compared the incidence of CI-AKI with either iodixanol or LOCM. Random-effects models were used to calculate summary risk ratios (RR) for CI-AKI, need for hemodialysis and death.

Michael Reed, MD, from the University of Michigan School of Medicine, VA Ann Arbor Healthcare System in Ann Arbor, and colleagues pooled a total of 16 trials involving 2,763 subjects.

Overall, they found that kidney injury occurred in 9.3 percent of patients who received iodixanol, compared to 11.5 percent patients who received LOCM.

The investigators found that there was no significant difference in the incidence of CI-AKI in the iodixanol group than in the LOCM group overall (RR: 0.79). There was no significant difference in the rates of post-procedure hemodialysis or death.

There was a reduction in CI-AKI when iodixanol was compared with Covidien's Hexabrix (ioxaglate) (RR: 0.58) and GE Healthcare's Omnipaque (iohexol) (RR: 0.19), but no difference when compared with Bracco Diagnostic's IsoVue (iopamidol) (RR: 1.20), Bayer HealthCare's Ultravist (iopromide) (RR: 0.93), or Covidien's Optiray (ioversol) (RR: 0.92).

The authors also noted that the relative renal safety of LOCM compared with iodixanol may vary based on the specific type of LOCM.