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There are four studies following i.v. injections fulfilling our inclusion criteria: Barrett et al.,443 Kuhn et al.,461 Thomsen et al.,462 and Nguyen et al.463 The overall conclusion, based on the evidence profile summarized in Suppl Table 20 comparing i.v. iso- vs. low-osmolar contrast media, is that there is no benefit for the nonionic iso-osmolar agent (iodixanol); the overall quality of the evidence is moderate. This conclusion is supported by the above-mentioned recent meta-analysis457 which, in seven studies comparing i.v. contrast-media administration with iodixanol vs. low-osmolar contrast media, showed no statistically significant difference for CI-AKI (RR 1.08; 95% CI 0.62–1.89; P = 0.79). Subgroup analysis did not show superiority of any agent in studies of individuals with normal kidney function (RR 1.12; 95% CI 0.35–3.65; P = 0.85) or in studies of individuals with reduced kidney function (RR 1.07; 95% CI 0.56–2.02; P = 0.84).
In head-to-head comparisons with different low-osmolar agents, iodixanol has been shown to be superior to iopromide, but not to iopamidol and iomeprol. It is, however, difficult to determine whether this is simply due to spurious findings in a smaller number of comparisons, or due to true differences between low-osmolar agents. Until better head-to-head comparative studies among the different contrast media agents are available, the Work Group is unable to draw definite conclusions on the selection of iso-osmolar vs. low-osmolar contrast media.
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