Contrast media: low-osmolality causes less nephrotoxicity than high-osmolality.

Clinical bottom line (level 1a)

  1. Patients undergoing contrast studies who are given low-osmolality contrast media are less likely to have an increase in creatinine levels over 44 micromol/ L than those given high-osmolality (NNT = 87 at 2 days) .
  2. They are also less likely to have creatinine over 90 micromol/ L (NNT = 60 at 2 days) .
  3. Patients with pre-existing renal impairment are less likely to have an increase in creatinine over 44 micromol/ L with low-osmolality contrast media (NNT = 130 at 2 days) .
Barrett and Carlisle: Radiology 1993; 188: 171-178
Expires October 2003

The study

Systematic review of randomised controlled trials of
  • Patients: undergoing contrast media study
  • Intervention: intravascularly administered low-osmolality contrast media compared with high-osmolality
  • Outcome: serum creatinine levels or glomerular filtration rates before and after receiving contrast media, or measured need for dialysis after receiving contrast media


    • Articles found in English using MEDLINE, EMBASE, 1982 to 1991 (search terms: ) and personal files, bibliographies of review articles and relevant papers, and contact with authors and pharmaceutical companies

    Selection criteria: as above
    Appraisal criteria: not detailed
    Articles excluded if:

    31 studies involving 5146 patients were included.
    No comment was made on heterogeneity.

    The evidence

    Outcome Time to outcome CER OR
    (95% CI)    		 NNT
    (95% CI)
    undergoing contrast study: increase in Cr levels >44 micromol/ L 2 days /
    (3.0%)    		 0.61
    (0.48 to 0.77)     		87
    (65 to 150)
    undergoing contrast study: increase in Cr of >90 micromol/ L 2 days /
    (3.0%)    		 0.44
    (0.26 to 0.73)     		60
    (45 to 130)
    pre-existing renal impairment, undergoing contrast study: increase in Cr >44 micromol/ L 2 days /
    (1.5%)    		 0.50
    (0.36 to 0.70)     		130
    (110 to 230)

    Citation

    1. Barrett BJ, and Carlisle EJ: Meta analysis of the relative nephrotoxicity of high- and low-osmolality iodinated contrast media. Radiology 1993; 188: 171-178
    Contributor: Clare Wotton and Musab Hayatli, October 2000
    Reviewer:

    Clinical Question.
    Patient undergoing contrast media study
    Intervention or Exposure low-osmolality contrast media
    Comparison high-osmolality
    Outcome nephrotoxicity