Abstract
BackgroundContrast-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.MethodsRandomized 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.ResultsA 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.ConclusionsWhether 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.
Highlights
Contrast-induced acute kidney injury (CI-AKI) is a major adverse effect caused by intravascular administration of iodinated contrast medium
Remaining articles were identified by scanning through abstracts and excluded based on whether or not including Confidence interval (CI)-AKI incidence rates in Characteristics of selected clinical trials All 15 trials used iodixanol as Iso-osmolar contrast media (IOCM), iopromide, iopamidol, iohexol, ioversol, and ioxaglate were used as low-osmolar contrast media (LOCM)
The difference between IOCM and LOCM was found when CI-AKI was defined as an absolute serum creatinine (SCr) increase (≥0.5 mg/dl) (Fig. 2), rather than a relative SCr increase (≥25%) (Additional file 3: Figure S3)
Summary
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. Contrast-induced acute kidney injury (CI-AKI) is a severe complication of exposure to iodine contrast media for diagnostic or interventional procedure [1], which accounts for increase in morbidity, mortality, length of stay. Radiology (ESUR) and the Kidney Disease: Improving Global Outcomes guidelines (KIDGO), Both IOCM and LOCM were recommended in patients with increased risk of CI-AKI [6, 7]. The risk for CI-AKI is significantly increased in patients with chronic kidney disease (CKD), especially when DM coexists [9].
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