Comparative effect of iso-osmolar versus low-osmolar contrast media on the incidence of contrast-induced acute kidney injury in diabetic patients: a systematic review and meta-analysis.

Abstract

BACKGROUND:

Contrast-induced acute kidney injury (CI-AKI) is a major adverse effect caused by intravascular administration of iodinated contrast medium. Whether there is a difference in CI-AKI incidence between iso-osmolar (IOCM) and low-osmolar contrast media (LOCM) among diabetic patients is controversial.

METHODS:

Randomized controlled trials comparing the nephrotoxic effects between IOCM and LOCM in diabetic patients with or without CKD (eGFR< 60 ml/min/1.73 m2) were included in the analysis. The incidence of CI-AKI was defined as an initial increase in serum creatinine (SCr) concentration of at least 0.5 mg/dl or a rise in creatinine of 25% from baseline.

RESULTS:

A total of 2190 patients were included, among whom 1122 patients received IOCM and 1068 received LOCM. When compared to LOCM, IOCM had no significant benefit in preventing CI-AKI (OR = 1.66, [CI: 0.97-2.84], P = 0.06, I2 = 54%). However, the difference between IOCM and LOCM was found when CI-AKI was defined as an absolute SCr increase (≥0.5 mg/dl) rather than a relative SCr increase (≥25%). Further analysis showed that LOCM resulted in more adverse events.

CONCLUSIONS:

Whether there is a difference of CI-AKI incidence between IOCM and LOCM in diabetic patients was related to the selected diagnostic criteria. The incidence of adverse events was significantly lower with IOCM when compared with LOCM. Therefore, we suggest that IOCM may be used in diabetic and CKD (eGFR< 60 ml/min/1.73 m2) patients.

• Authors: Fei Zhao, Rong Lei, Shi-Kun Yang, Min Luo, Wei Cheng, Ye-Qing Xiao, Xu-Wei Li, Jun Guo, Shao-Bin Duan
• Journal: Cancer imaging : the official publication of the International Cancer Imaging Society (Cancer Imaging) Vol. 19 Issue 1 Pg. 38 (Jun 18 2019) ISSN: 1470-7330 [Electronic] England
• PMID: 31215488 (Publication Type: Comparative Study, Journal Article, Meta-Analysis, Systematic Review)

Chemical References

• Contrast Media

Topics

• Acute Kidney Injury (epidemiology, etiology)
• Contrast Media (adverse effects, chemistry)
• Diabetes Mellitus (epidemiology)
• Female
• Humans
• Male
• Osmolar Concentration
• Randomized Controlled Trials as Topic