U.S. flag

An official website of the United States government

NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.

Cover of Contrast-Induced Nephropathy

Contrast-Induced Nephropathy

Comparative Effects of Different Contrast Media

Comparative Effectiveness Reviews, No. 155

Investigators: , MD, , MD, PhD, MPH, , MS, , MD, MHS, , MD, , BS, , MD, , MD, MPH, , PhD, , MBChB, MPH, and , MD, MPH.

Author Information and Affiliations
Rockville (MD): Agency for Healthcare Research and Quality (US); .
Report No.: 15(16)-EHC022-EF

Structured Abstract

Objectives:

To evaluate the comparative effects of different types of contrast media with respect to the risk of developing contrast-induced nephropathy (CIN) by synthesizing the current literature.

Data sources:

We searched for original studies in MEDLINE®, Embase®, and the Cochrane Library through October 1, 2014. We also searched for studies in ClinicalTrials.gov and the Scopus database.

Methods:

Two reviewers independently reviewed each article to identify randomized controlled trials (RCTs) that reported on CIN-related outcomes in patients after receiving low-osmolar contrast media (LOCM) or iso-osmolar contrast media (IOCM). We included head-to-head comparisons of one LOCM versus another LOCM or of LOCM versus IOCM. (Only 1 IOCM is currently available in the United States.) For each study, one reviewer extracted the data and a second reviewer verified the accuracy. Both reviewers assessed the risk of bias for each study. Together, the reviewers graded the strength of evidence for the comparisons and outcomes of interest. We quantitatively pooled the results of studies that were sufficiently similar, using a 25-percent relative risk reduction as the threshold for a minimally important difference.

Results:

We identified five RCTs that compared two or more LOCMs, including two studies of intra-arterial administration, two studies of intravenous administration, and one study examining both routes. We identified 25 RCTs that compared IOCM with LOCM, including 18 studies of intra-arterial administration and 7 studies of intravenous administration. No study comparing LOCMs reported a statistically significant or clinically important difference between study arms, and the overall analysis did not suggest that any one LOCM was superior to another. In a meta-analysis, we found a borderline significant reduction in short-term CIN risk with IOCM compared with a diverse group of LOCMs (pooled relative risk, 0.80; 95% confidence interval [CI], 0.65 to 0.99, p=0.045). When the analysis was stratified by route of administration, the aggregate pooled relative risk was 0.80 (95% CI, 0.64 to 1.01) for intra-arterial and 0.84 (95% CI, 0.42 to 1.71) for intravenous. In studies that investigated IOCM versus LOCM, the outcomes of mortality, cardiovascular outcomes, need for renal replacement therapy, and imaging quality or diagnostic accuracy showed no significant difference between groups. One study comparing different LOCMs investigated the outcomes of death and adverse events, and found no difference between groups.

Conclusions:

We found low strength of evidence that the risk of CIN did not differ between LOCMs, and moderate strength of evidence that IOCM had a slightly lower risk of CIN than LOCM. The lower risk was not clinically important and just reached statistical significance.

Contents

Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services1. Contract No. 290-2012-00007-I. Prepared by: Johns Hopkins University Evidence-based Practice Center, Baltimore, MD

Suggested citation:

Eng J, Subramaniam RM, Wilson RF, Turban S, Choi MJ, Zhang A, Suarez-Cuervo C, Sherrod C, Hutfless S, Iyoha EE, Bass EB. Contrast-Induced Nephropathy: Comparative Effects of Different Contrast Media. Comparative Effectiveness Review No. 155. (Prepared by the Johns Hopkins University Evidence-based Practice Center under Contract No. 290-2012-00007-I.) AHRQ Publication No. 15(16)-EHC022-EF. Rockville, MD: Agency for Healthcare Research and Quality; December 2015. www.effectivehealthcare.ahrq.gov/reports/final.cfm.

This report is based on research conducted by the Johns Hopkins University Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-2012-00007-I). The findings and conclusions in this document are those of the authors, who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.

The information in this report is intended to help health care decisionmakers—patients and clinicians, health system leaders, and policymakers, among others—make well informed decisions and thereby improve the quality of health care services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information, i.e., in the context of available resources and circumstances presented by individual patients.

AHRQ or U.S. Department of Health and Human Services endorsement of any derivative products that may be developed from this report, such as clinical practice guidelines, other quality enhancement tools, or reimbursement or coverage policies, may not be stated or implied.

This report may periodically be assessed for the currency of conclusions. If an assessment is done, the resulting surveillance report describing the methodology and findings will be found on the Effective Health Care Program Web site at www.effectivehealthcare.ahrq.gov. Search on the title of the report.

None of the investigators have any affiliations or financial involvement that conflicts with the material presented in this report.

1

540 Gaither Road, Rockville, MD 20850; www​.ahrq.gov

Bookshelf ID: NBK343526PMID: 26854293

Views

  • PubReader
  • Print View
  • Cite this Page
  • PDF version of this title (5.6M)

Related publications

Related information

Similar articles in PubMed

See reviews...See all...

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...