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Meta-Analysis
. 2019 Jun 18;19(1):38.
doi: 10.1186/s40644-019-0224-6.

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

Fei Zhao  1 , Rong Lei  2 , Shi-Kun Yang  3 , Min Luo  1 , Wei Cheng  1 , Ye-Qing Xiao  1 , Xu-Wei Li  1 , Jun Guo  1 , Shao-Bin Duan  4
Affiliations
Meta-Analysis

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

Fei Zhao et al. Cancer Imaging. .

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.

Keywords: Acute kidney injury; Contrast media; Diabetes.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Comparison of the outcomeof CI-AKI between IOCM and LOCM. Odds ratio for individual studies (squares) and meta-analysis (diamonds) and 95% CI (horizontal lines) are shown
Fig. 2
Fig. 2
IOCM vs. LOCM for the outcome of CI-AKI (defined by an initial increase in SCr concentration of at least 0.5 mg/dl within 36–72 h of exposure). Odds ratio for individual studies (squares) and meta-analysis (diamonds) and 95% CI (horizontal lines) are shown
Fig. 3
Fig. 3
IOCM vs. LOCM for the outcome of adverse events. Odds ratio for individual studies (squares) and meta-analysis (diamonds) and 95% CI (horizontal lines) are shown
See this image and copyright information in PMC

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