Low-Osmolar Vs. Iso-Osmolar Contrast Media on the Risk of Contrast-Induced Acute Kidney Injury: A Propensity Score Matched Study

Overview

Journal Front Med (Lausanne)

Specialty General Medicine

Date 2022 May 16

PMID 35572997

Authors

Taeho Lee

Won Ki Kim

Ae Jin Kim

Han Ro

Jae Hyun Chang

Hyun Hee Lee

Wookyung Chung

Ji Yong Jung

Affiliations

Soon will be listed here.

Abstract

Objective: Among the various risk factors associated with contrast-induced acute kidney injury (CI-AKI), the importance of osmolality and viscosity is emerging among the characteristics of contrast media (CM) itself. High osmolality CM (HOCM) is deprecated and low osmotic pressure (LOCM) and iso-osmotic pressure (IOCM) are mainly used in clinical situations where the results of studies on their effect on the development of CI-AKI are contradictory. We evaluated the association between the type of CM and the risk of CI-AKI.

Materials And Methods: A retrospective observational cohort study to analyze the effect of the type of CM on the development of CI-AKI. Using propensity score (PS) matching, 2,263 LOCM and IOCM groups were paired for analysis from 5,267 patients and fulfilled the inclusion criteria among 12,742 patients who underwent CAG between 1 January 2007, and 31 December 2016. LOCM included iopromide and iopamidol, IOCM was iodixanol. CI-AKI, which was the primary endpoint, was defined based on the Kidney Disease Improving Global Outcomes criteria within 48 h after exposure to the CM. A multivariable logistic regression analysis was used in the unmatched and matched cohorts, respectively. In addition, a stratified model on clinically important variables, including a high Mehran score (≥ 6), was also used in the matched cohort.

Results: LOCM users showed an increased incidence of CI-AKI (11.7% vs. 9.3%; = 0.006), but it lost statistical significance after PS matching (9.9% vs. 9.5%, = 0.725). In multivariable analyses, the adjusted odds ratio for CI-AKI in the LOCM group were 1.059 [95% confidence interval (CI) = 0.875-1.282; = 0.555] in unmatched cohort and 0.987 (95% CI = 0.803-1.214; = 0.901) in matched cohort. These results were also consistent with the high-risk (high Mehran score) group.

Conclusions: Although the role of CM types in the development of CI-AKI has been debated, our observation shows that the selection between LOCM and IOCM during CAG has no influence on the incidence of CI-AKI.

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