The Relative Renal Safety Of Iso-osmolar Contrast Media Compared With Low-osmolar Contrast Media:Meta-analysis Of Randomized Controlled Trials

Background:Contrast-induced nephropathy (CIN) is a common cause of renal failure in hospitalized patients, although rarely lead directly to death, or to be given immediate dialysis treatment, but the disease can lead to increased health care costs, prolonged hospitalization and long-term morbidity and mortality. Meta-analysis of past had shortcomings bias, and failed to incorporate the latest randomized controlled trials and randomized studies published in Chinese.Objective:This study aimed to control renal toxicity between iso-osmolar contrast media and low-osmolar contrast media(LOCM).Methods:We searched through computer relevant databases and network resources by from building a database retrieval time period to January,2014, and manually retrieve related magazines. Included the use of iodixanol or LOCM controlled study conducted CIN incidence randomized controlled trials (RCT). Screened by two reviewers independently extracted data and literature, according to a Cochrane Systematic Review Manual5.1.0recommended six quality evaluation criteria for risk of bias assessment of included studies; using GRADE PRO3.6software of quality classification. Using Revman5.2Meta-analysis software. Calculated using a fixed effects model CIN, requiring dialysis treatment, and total mortality risk ratio.Results:1, Eventually our study included44randomized controlled trials involving8931patients, the overall results of the study tended to iodixanol, iodixanol group the risk is relatively lower than LOCM group and was statistically significant (RR:1.27,95%CI:1.08-1.50; P=0.004).2,Subgroup analysis results are shown:According to the contrast agent injection route showed intra-arterial administration of iodixanol relative risk of less than LOCM group (RR:1.41,95%CI:1.16-1.73; P=0.0007). However, intravenous administration of iodixanol and LOCM was no statistically significant difference (RR:0.81,95%CI:0.48-1.36; P=0.42). 3, According to the reason for the use of contrast agents, contrast agents checked by coronary angiography or Percutaneous Coronary Intervention(PCI), Meta analysis results indicated that the relative risk of iodixanol group less than LOCM group(RR:1.45,95%CI:1.10-1.92; P=0.009). Through CT examination (RR:0.78,95%CI:0.46-1.34; P=0.37), coronary angiography (RR:1.08,95%CI:0.61-1.94; P=0.78), intravenous urography (RR:1.00,95%CI:0.15-6.85; P=1.00) were not statistically different.4, According to the different types of LOCM stratified analysis results show that, Meta analysis results show that the incidence of CIN iodixanol relative risk of less than iodine grams acid (RR:1.65,95%CI:1.05-2.61; P=0.03), iopromide (RR:1.62,95%CI:1.15-2.29; P=0.006), iohexol (RR:2.41,95%CI:1.33-4.36; P=0.004) and were statistically different. The study also found that the relative risk is higher than iomeprol (RR:0.39,95%CI:0.16-0.96; P=0.04). Study was not observed with iodixanol and ioversol (RR:1.37,95%CI:0.84-2.23; P=0.21), iopamidol (RR:0.91,95%CI:0.60-1.39; P=0.67) CIN exists between the risk relative differences.5, For diabetics and non-diabetics patients, the relative risk of iodixanol group was not lower than LOCM group(RR:1.41,95%CI:0.97-2.06; P=0.07) and (RR:0.44,95%CI:0.15-1.28; P=0.13).Conclusion:1、The Meta analysis showed that, on the whole, CIN incidence application iodixanol be lower than LOCM.2、By coronary angiography or PCI, the relative risk of iodixanol group below LOCM group.3、But after intravenous administration,the relative risk of application of iodixanol group was not lower than LOCM.4、For diabetics and non-diabetics patients, the relative risk of application of iodixanol group was not lower than LOCM.5、Relative to iodixanol,LOCM relative renal safety because of the specific type of LOCM differ.