Reed Michael, Meier Pascal, Tamhane Umesh U, Welch Kathy B, Moscucci Mauro, Gurm Hitinder S
University of Michigan School of Medicine, VA Ann Arbor Healthcare System, University of Michigan, Ann Arbor, MI 48109-5853, USA.
JACC Cardiovasc Interv. 2009 Jul;2(7):645-54. doi: 10.1016/j.jcin.2009.05.002.
We sought to compare the nephrotoxicity of the iso-osmolar contrast medium, iodixanol, to low-osmolar contrast media (LOCM).
Contrast-induced acute kidney injury (CI-AKI) is a common cause of in-hospital renal failure. A prior meta-analysis suggested that iodixanol (Visipaque, GE Healthcare, Princeton, New Jersey) was associated with less CI-AKI than LOCM, but this study was limited by ascertainment bias and did not include the most recent randomized controlled trials.
We searched Medline, Embase, ISI Web of Knowledge, Google Scholar, Current Contents, and International Pharmaceutical Abstracts databases, and the Cochrane Central Register of Controlled Trials from 1980 to November 30, 2008, for randomized controlled trials that compared the incidence of CI-AKI with either iodixanol or LOCM. Random-effects models were used to calculate summary risk ratios (RR) for CI-AKI, need for hemodialysis, and death.
A total of 16 trials including 2,763 subjects were pooled. There was no significant difference in the incidence of CI-AKI in the iodixanol group than in the LOCM group overall (summary RR: 0.79, 95% confidence interval [CI]: 0.56 to 1.12, p = 0.19). There was no significant difference in the rates of post-procedure hemodialysis or death. There was a reduction in CI-AKI when iodixanol was compared with ioxaglate (RR: 0.58, 95% CI: 0.37 to 0.92; p = 0.022) and iohexol (RR: 0.19, 95% CI: 0.07 to 0.56; p = 0.002), but no difference when compared with iopamidol (RR: 1.20, 95% CI: 0.66 to 2.18; p = 0.55), iopromide (RR: 0.93, 95% CI: 0.47 to 1.85; p = 0.84), or ioversol (RR: 0.92, 95% CI: 0.60 to 1.39; p = 0.68).
This meta-analysis including 2,763 subjects suggests that iodixanol, when compared with LOCM overall, is not associated with less CI-AKI. The relative renal safety of LOCM compared with iodixanol may vary based on the specific type of LOCM.
我们旨在比较等渗造影剂碘克沙醇与低渗造影剂（LOCM）的肾毒性。
对比剂诱导的急性肾损伤（CI-AKI）是住院患者肾衰竭的常见原因。先前的一项荟萃分析表明，碘克沙醇（威视派克，通用电气医疗集团，新泽西州普林斯顿）与CI-AKI的相关性低于低渗造影剂，但该研究受确定偏倚的限制，且未纳入最新的随机对照试验。
我们检索了1980年至2008年11月30日的Medline、Embase、ISI Web of Knowledge、谷歌学术、《现刊目次》和《国际药学文摘》数据库以及Cochrane对照试验中心注册库，以查找比较碘克沙醇或低渗造影剂与CI-AKI发生率的随机对照试验。采用随机效应模型计算CI-AKI、血液透析需求和死亡的汇总风险比（RR）。
共纳入16项试验，涉及2763名受试者。总体而言，碘克沙醇组CI-AKI的发生率与低渗造影剂组相比无显著差异（汇总RR：0.79，95%置信区间[CI]：0.56至1.12，p = 0.19）。术后血液透析率或死亡率无显著差异。与碘克酸（RR：0.58，95% CI：0.37至0.92；p = 0.022）和碘海醇（RR：0.19，95% CI：0.07至0.56；p = 0.002）相比，碘克沙醇组的CI-AKI有所降低，但与碘帕醇（RR：1.20，95% CI：0.66至2.18；p = 0.55）、碘普罗胺（RR：0.93，95% CI：0.47至1.85；p = 0.84）或碘佛醇（RR：0.92，95% CI：0.60至1.39；p = 0.68）相比无差异。
这项纳入2763名受试者的荟萃分析表明，总体而言，与低渗造影剂相比，碘克沙醇与较少的CI-AKI无关。低渗造影剂与碘克沙醇相比的相对肾脏安全性可能因低渗造影剂的具体类型而异。
