Markus Weininger MD, Presenter: Research support, Siemens AG

U. Joseph Schoepf MD, Abstract Co-Author: Speakers Bureau, Bracco Group Speakers Bureau, General Electric Company Speakers Bureau, Bayer AG Speakers Bureau, Siemens AG Medical Advisory Board, Siemens AG Medical Advisory Board, Bayer AG Research grant, Bayer AG Research grant, Bracco Group Research grant, General Electric Company Research grant, Siemens AG

Luis Raul Ramos-Duran MD, Abstract Co-Author: Nothing to Disclose

Philip Costello MD, Abstract Co-Author: Nothing to Disclose

Kelly H. Zou PhD, Abstract Co-Author: Employee, Pfizer Inc

Various clinical trials compare the effect of intravenous (IV) iodinated contrast media (CM) on renal function at CT, using contrast-induced nephropathy (CIN) as primary endpoint. Our systematic review assesses adverse patient outcomes following IV CM administration beyond laboratory markers.

A systematic literature search was conducted by 2 reviewers using the following inclusion criteria: 1) Full peer-reviewed article; 2) Prospective trial; 3) IV administration of non-ionic CM at CT; 4) High-risk patient population with decreased renal function; 5) Serum creatinine (SCr) measurements before and after CM administration; 6) Quantitative evaluation for CM related adverse outcomes. Definition of CIN, type of CM, mechanisms to control for bias, incidence of CIN and of adverse outcomes were abstracted. A third reviewer adjudicated in case of discrepancies. Meta-analysis methods for combining the counts and proportion with 95% confidence intervals (CI), forest plots, and Spearman’s correlations were employed.

8 studies were identified fulfilling the inclusion criteria, comprising 1625 patients with decreased renal function (baseline SCr 1.41±0.38 to 2.1±0.6 mg/dl; GFR 37±12 to 52.98±26.02 ml/min). All studies defined CIN as absolute (≥0.5mg/dl) or relative (≥25%) increase in baseline SCr. 292 patients received iopamidol, 794 iodixanol, 76 iomeprol, 59 iohexol and 56 iopromide. For 348 patients CM was not specified. Mean CM volume ranged from 100 to 125 ml. Pooled proportions of patients of at risk patients with increases in SCr from baseline fulfilling definitions of absolute and relative CIN were 5.31% (95% CI: 3.83%-6.79%; range 0%-17.86%) and 7.07% (95% CI: 5.50%-8.63%; range 3.90%-26.79%). No study observed any clinically manifest CM related adverse outcome, corrected for natural SCr fluctuations, or assessed long term effects of CM on renal function.

The available literature shows a varied incidence of increasing SCr after IV CM administration, meeting the definition of CIN. However, different from intra-arterial administration, there were no reports of clinically manifest adverse outcomes after IV injection. Thus, the usefulness of CIN as a meaningful endpoint to compare the safety of different IV CM may be limited. 

Although IV CM administration in high-risk patients is frequently associated with increases in SCr, clinically manifest adverse outcomes are rare.

Weininger, M, Schoepf, U, Ramos-Duran, L, Costello, P, Zou, K, Contrast-induced Nephropathy: Does It Matter for Computed Tomography? A Systematic Review.  Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL. http://archive.rsna.org/2010/9004863.html