Introduction
Materials and methods
Study selection
Data extraction and study quality assessment
Results
Study selection
Study | Country | Study Design | Indication & Population | Renal exposure | Age & Gender | Contrast Media | Dose | N patients | Quality Score a |
---|---|---|---|---|---|---|---|---|---|
Outcome: PC-AKI incidence | |||||||||
Azzalini 2018 [16] | Italy | R, S | PCI in adult patients | 2nd | Ioversol 68.0 ± 11.5 years Male: 81% Iopromide 67.9 ± 11.3 years Male: 82% Iomeprol 68.1 ± 11.6 years Male: 81% Iobitridol 68.1 ± 11.1 years Male: 80% Iodixanol 68.5 ± 11.4 years Male: 80% | Ioversol 350 Iopromide 370 Iomeprol 350 Iobitridol 350 Iodixanol 320 | 232 ± 113 mL 233 ± 123 mL 228 ± 126 mL 243 ± 129 mL 209 ± 111 mL | 272 818 611 460 487 | 7 |
El-saadani 2017 [22] | Egypt | RCTb, O, S | PCI in adult patients | 2nd | 52.3± 6.6 years Male: 61.7% | Ioversol 350 | NR | 60 | 5 |
Fu 2018 [42] | China | RCTb, M | PCI in adult patients | 2nd | Probucol group 60.3 ± 11.7 years Male: 57% Control group 61.9 ± 12.4 years Male: 59% | Ioversol | Probucol group 148 ± 11 mL Control group 150 ± 11 mL | 641 | 5 |
Cao 2018 [40] | China | RCTb, S | PCI in adult patients | 2nd | Male: 88% With RIPostC 59 ±13 years Without RIPostC 59 ±11 years | Ioversol | With RIPostC 88 ± 23 mL Without RIPostC 92 ± 20 mL | 64 | 5 |
Call 2006 [19] | USA | P, S | Coronary angiography or PCI in adult patients | 2nd | Automated injection 64.9±12.5 years Male: 63.9% Hand injection 64.0±12.6 years Male: 63.0% | Ioversol 350 | Automated injection 145.6±107.6 mL Hand injection 204.3±147.1 mL | 2175 | 6 |
Hernandez 2009 [23] | Spain | P, S, O | Coronary angiography with or without PCI in diabetic patients | 2nd | Ioversol 70.1±7.9 years Male: 64.4% Iodixanol 69.1±9.0 years Male: 61.9% | Ioversol 350 Iodixanol 270 | 195.5±92.1 mL 194.5±80.7 mL | 132 118 | 7 |
Zaki 2015 [32] | Egypt | P, S | Coronary angiography or PCI in diabetic patients | 2nd | 57.73±7.50 years Male: 64.8% | Ioversol 300 | 165.9 ±88.9 mL | 250 | 5 |
Wróbel 2010 [31] | Poland | RCTb, S | Coronary angiography and/or PCI in diabetic patients | 2nd | 67±7.8 years Male: 56.9% | Ioversol 350 | IV hydration 101.1 ± 36.6 mL Oral hydration 110.4 ± 65.3 mL | 102 | 7 |
Rudnick 2008 [27] | USA & Canada | RCT, DB, M | Coronary angiography in patients with CKD | 2nd | Ioversol 72.6 ± 10.2 years Male: 73.8% Iodixanol 71.1 ± 9.9 years Male: 68.2% | Ioversol 320 Iodixanol 320 | 129.9 ± 80.8 mL 118.4 ± 83.8 mL | 143 156 | Low risk of bias |
Cho 2010 [20] | USA | RCTb, S | Coronary angiography in patients with CKD | 2nd | 78±8 years Male: 50.5% | Ioversol 320 | IV fluid 122.6 mL IV bicarbonate & fluid 136.3 mL Oral fluid 118.6 mL Oral bicarbonate & fluid 136.5 mL | 91 | 5 |
Baskurt 2009 [18] | Turkey | RCTb, S | Coronary angiography in patients with moderate CKD | 2nd | 67.4±9.8 years | Ioversol | IV hydration 113.5±37.7 mL IV hydration + NAC 115.6±35.2 mL IV hydration + NAC+Theophilline 130.7±44.5 mL | 217 | 5 |
Azzalini 2019 [17] | Italy | R, S | Coronary angiography with PCI in patients with severe CKD | 2nd | 76 (71-81) years Male: 76% | Ioversol | 85 (50-140) mL | 111 | 5 |
Abaci 2015 [15] | Turkey | RCTb, S | Coronary or peripheral angiography in patients with CKD | 2nd | Control 67.7±8.9 years Male: 73.4% Rosuvastatin 67.5±8.9 years Male: 64% | Ioversol | Control 117.7±56.8 mL Rosuvastatin 139.2±77.4 mL | 208 | 5 |
Komenda 2007 [25] | Canada | Rc, S | Coronary or peripheral vessel angiography or angioplasty and stenting in patients with CKD | 1st | 64±13.8 years Male: 48% | Ioversol 320 | NR | 31 | 5 |
Cury 2018 [21] | Brazil | P, S | Peripheral angiography in patients with critical limb ischemia | 2nd | 70.5±10.7 years Male: 57% | Ioversol 320 | 148.5±79.4 mL | 107 | 5 |
Sharma 2013 [29] | USA | R, S | Cerebral angiography in patients undergoing endovascular treatment of acute ischemic stroke | 2nd | 65±14 years Male: 48% | Ioversol 320 | 150 mL | 194 | 5 |
Krol 2007 [26] | Canada | R, S | Cerebral angiography in patients with acute stroke syndrome | 2nd | 68.2±14.1 years Male: 62% | Ioversol 320 | 75-100 mL | 224 | 5 |
Xu 2017 [41] | China | P, S | Angiography in adult patients | 2nd | 52.1 ± 14.5 years Male: 77% | Ioversol 320 | PC-AKI 50±24 mL No PC-AKI 62±10 mL | 213 | 5 |
Hirsch 2007 [24] | USA | P, S | Coronary angiography in pediatric patients with congenital heart diseases | 2nd | No PC-AKI 6.6±3.2 years Male: 58% PC-AKI 7.3±3.1 years Male: 55% | Ioversol 350 | No PC-AKI 3.4±0.2 mL/kg PC-AKI 4.2±0.6 mL/kg | 91 | 5 |
Outcome: HSRs incidence | |||||||||
Sohn 2019 [30] | Korea | P, S | Coronary angiography with or without PCI in adult patients | 2nd | 62.9 ± 10.3 years Male: 71.0% | Ioversol 320 Iodixanol | NR | 416 298 | 5 |
Outcome: ADRs incidence | |||||||||
Cutcliff 1989 [33] | USA | DB, RCT, S | Peripheral and visceral arteriography in adult patients | 2nd | 19-85 years Male: 70% | Ioversol 320 Iohexol 300 | Peripheral procedures 100 mL 96 mL Visceral procedures 87 mL 135 mL | 30 30 | Low risk of bias |
Grassi 1989 [34] | USA | DB, RCT, S | Peripheral and visceral arteriography in adult patients | 2nd | NR | Ioversol 320 Diatrizoate 282 | Peripheral procedures 159 (41-275) mL 165 (39-247) mL Visceral procedures 178 (76-282) mL 162 (60-334) mL | 30 30 | Low risk of bias |
Ringel 1989 [38] | Germany | DB, RCT, S | Cerebral angiography in adult patients | 2nd | Ioversol 57 (31-81) years Male: 67% Iopamidol 59 (24-77) years Male: 70% | Ioversol 320 Iopamidol 300 | 29 (8-110) mL 23 (11-75) mL | 30 30 | Low risk of bias |
McGaughey 1991 [36] | USA & Germany | DB, RCT, M | Coronary arteriography in adult patients | 2nd | Ioversol 61 (33-84) years Male: 71% Iohexol 56 (36-78) years Male: 78% | Ioversol 350 Iohexol 350 | 123 (61-242) mL 125 (73-230) mL | 80 80 | Low risk of bias |
Hirshfeld 1989 [35] | USA | DB, RCT, S | Coronary angiography in adult patients | 2nd | Ioversol 59±11 years Male: 70% Iopamidol 59±11 years Male: 87% Diatrizoate 59±12 years Male: 63% | Ioversol 320 Iopamidol 370 Diatrizoate 370 | 141±42 mL 131±41 mL 141±41 mL | 60 30 30 | Low risk of bias |
Reagan 1988 [39] | USA | DB, RCT, S | Coronary angiography in adult patients | 2nd | NR | Ioversol 320 Diatrizoate 370 | NR | 40 40 | Low risk of bias |
Miller 1989 [37] | USA | OL, S | Intra-arterial digital subtraction angiography in adult patients | 2nd | 19-84 years Male: 45% | Ioversol 160 | 110 mL | 40 | 5 |
Senthilnathan 2009 [28] | USA | P, S | Coronary angiography in pediatric patients with congenital heart diseases | 2nd | <1 year: 31% 1-10 years: 48% 11-17 years: 21% Gender: NR | Ioversol 350 | 3.9 (2-6) mL/kg d | 2321 | 5 |
Post-contrast acute kidney injury
Study | Contrast Media | N Patients | PC-AKI Definition | Incidence (%) | ||||
---|---|---|---|---|---|---|---|---|
Azzalini 2018 [16] | AKIN definition: | Overall | St 1 | St 2 | St 3 | Dialysis | ||
Ioversol | 272 | Stage 1: sCr rise ≥0.3 mg/dL or ≥50-100%; | 13.0% | 10.3% | 0.8% | 1.9% | 0% | |
Iopromide | 818 | Stage 2: sCr rise >100-200%; | 11.5% | 8.7% | 1.6% | 1.3% | 0.5% | |
Iomeprol | 611 | Stage 3: sCr rise >200% or ≥4.0 mg/dL with an acute increase of ≥0.5 mg/dL. | 10.2% | 9.2% | 0.7% | 0.3% | 0.3% | |
Iobitridol | 460 | 13.9% | 11.7% | 1.3% | 0.9% | 0% | ||
Iodixanol | 487 | 11.3% | 10% | 0.9% | 0.4% | 0.4% | ||
El-saadani 2017 [22] | Ioversol | 60 | sCr rise ≥25% within 48h | 11.7% | ||||
Fu 2018 [42] | Ioversol | 641 | sCr rise ≥25% within 72h | 7.5% | ||||
Cao 2018 [40] | Ioversol | 64 | sCr rise ≥25% within 72h | 21.9% | ||||
Call 2006 [19] | Ioversol | 2175 | sCr rise >0.5 mg/dL or >25% within 7 days | Automated injection: 13.3% a Hand injection: 19.3% | ||||
Hernandez 2009 [23] | Ioversol | 132 | sCr rise >0.5 mg/dL or >25% at 72h post procedure | 8.3% a | ||||
Iodixanol | 118 | 2.5% | ||||||
Zaki 2015 [32] | Ioversol | 250 | sCr rise ≥0.5 mg/dL within 48–72h | 23.2% | ||||
Wróbel 2010 [31] | Ioversol | 102 | sCr rise ≥0.5 mg/dL or ≥25% at 72h post procedure | IV hydration: 5.8% Oral hydration: 4% | ||||
Rudnick 2008 [27] | Ioversol | 143 | sCr rise ≥0.5 mg/dL within 72h | 23.8% | ||||
Iodixanol | 156 | 21.8% | ||||||
Cho 2010 [20] | Ioversol | 91 | sCr rise >0.5 mg/dL or >25% at 72 hours post procedure | 11% | ||||
Baskurt 2009 [18] | Ioversol | 217 | sCr rise >0.5 mg/dL within 48h | 5.5% | ||||
Azzalini 2019 [17] | Ioversol | 111 | AKIN definition: | Overall: 15.5% b | ||||
Stage 1: sCr rise ≥0.3 mg/dL or ≥50-100%; | 9.7% | |||||||
Stage 2: sCr rise >100-200%; | 0% | |||||||
Stage 3: sCr rise >200% or ≥4.0 mg/dL with an acute increase of ≥0.5 mg/dL. | 5.8% | |||||||
Abaci 2015 [15] | Ioversol | 208 | sCr rise >0.5 mg/dL or ≥25% within 48–72h | 7.2% | ||||
Komenda 2007 [25] | Ioversol | 31 | sCr rise > 25% | 9.1% | ||||
Cury 2018 [21] | Ioversol | 107 | sCr rise ≥25% within 5 days | 35.5% | ||||
Sharma 2013 [29] | Ioversol | 194 | sCr rise >0.3 mg/dL or >50% within 48h | 1.5% | ||||
Krol 2007 [26] | Ioversol | 224 | sCr rise ≥ 25% within 5 days | 3% | ||||
Xu 2017 [41] | Ioversol | 213 | sCr rise >0.3 mg/dL or >50% within 48–72h | 8% | ||||
Hirsch 2007 [24] | Ioversol | 91 | sCr rise ≥ 50% | 12% |
Post-contrast acute kidney injury in general population undergoing PCI or coronary angiography
Post-contrast acute kidney injury in diabetic patients undergoing coronary angiography or PCI
Post-contrast acute kidney injury in CKD patients undergoing coronary angiography or PCI
Post-contrast acute kidney injury in pediatric patients undergoing coronary angiography
Post-contrast acute kidney injury in patients undergoing direct renal stenting
Post-contrast acute kidney injury in other indications
Other safety outcomes
Study | Contrast Media | N Patients | Incidence (%) |
---|---|---|---|
Cutcliff 1989 [33] | Ioversol | 30 | 0% |
Iohexol | 30 | 3.3% | |
Grassi 1989 [34] | Ioversol | 30 | 3.3% |
Diatrizoate | 30 | 16.7% | |
Ringel 1989 [38] | Ioversol | 30 | 3.3% |
Iopamidol | 30 | 6.7% | |
McGaughey 1991 [36] | Ioversol | 80 | 0% |
Iohexol | 80 | 2.5% | |
Hirshfeld 1989 [35] | Ioversol | 60 | 1.7% |
Iopamidol | 30 | 0% | |
Diatrizoate | 30 | 20% | |
Reagan 1988 [39] | Ioversol | 40 | 5% |
Diatrizoate | 40 | 7.5% | |
Miller 1989 [37] | Ioversol | 40 | 0% |
Senthilnathan 2009 [28] | Ioversol | 2321 | 0.09% |