| Outcome | RCTs (N) | Study Limitations | Directness | Consistency | Precision | Strength of Evidence* | Summary of Key Outcomes |
|---|---|---|---|---|---|---|---|
| Development of CIN | 25 (5,097) | Medium | Direct | Consistent | Precise | Moderate | Moderate strength of evidence that IOCM had a slightly lower risk of CIN than LOCM; the point estimate of this reduction did not exceed a minimally important relative risk difference of 25% and is unlikely to be clinically important. |
| Development of CIN (IV administration) | 6 (790) | Medium | Direct | Consistent | Imprecise | Low | Low strength of evidence that IV IOCM had a slightly lower risk of CIN than IV LOCM; the point estimate of this reduction did not exceed a minimally important relative risk difference of 25% and is unlikely to be clinically important. |
| Development of CIN (IA administration) | 18 (4,194) | Medium | Direct | Consistent | Precise | Moderate | Moderate strength of evidence that IA IOCM had a slightly lower risk of CIN than IA LOCM; the point estimate of this reduction did not exceed a minimally important relative risk difference of 25% and is unlikely to be clinically important. |
| Need for RRT | 5 (1,740) | Medium | Direct | Consistent | Imprecise | Low | Low strength of evidence that the need for RRT does not differ between IOCM and LOCM. |
| Cardiovascular outcomes | 7 (2,258) | Medium | Direct | Consistent | Imprecise | Low | Low strength of evidence that cardiovascular outcomes do not differ between IOCM and LOCM. |
| Mortality | 8 (2,028) | Medium | Direct | Consistent | Imprecise | Low | Low strength of evidence that mortality does not differ between IOCM and LOCM. |
| Adverse events | 12 (3,363) | Medium | Direct | Consistent | Imprecise | Low | Low strength of evidence that adverse event rates do not differ between IOCM and LOCM. |
CIN = contrast induced nephropathy; IA = intra-arterial; IOCM = iso-osmolar contrast medium; IV = intravenous; LOCM = low-osmolar contrast medium; NA = not assessed; RCT = randomized controlled trial; RRT = renal replacement therapy
Due to heterogeneity in the study limitations across studies, the median study limitation value was chosen when distribution across studies was normal. In the instance where there is a split between study limitation scores, the more conservative study limitation designation was chosen.
From: Results
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