Nephropathy after administration of iso-osmolar and low-osmolar contrast media: Evidence from a network meta-analysis

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.