A systematic review of the incidence of hypersensitivity reactions and post-contrast acute kidney injury after ioversol: part 2-intra-arterial administration

Aart J van der Molen; Ilona A Dekkers; Ibrahim Bedioune; Elisabeth Darmon-Kern

doi:10.1007/s00330-022-08637-2

A systematic review of the incidence of hypersensitivity reactions and post-contrast acute kidney injury after ioversol: part 2-intra-arterial administration

Eur Radiol. 2022 Aug;32(8):5546-5558. doi: 10.1007/s00330-022-08637-2. Epub 2022 Mar 21.

Authors

Aart J van der Molen¹, Ilona A Dekkers², Ibrahim Bedioune³, Elisabeth Darmon-Kern³

Affiliations

¹ Contrast Media Safety Research Group, Department of Radiology C-2S, Leiden University Medical Center, Albinusdreef 2, NL-2333, ZA, Leiden, The Netherlands. a.j.van_der_molen@lumc.nl.
² Contrast Media Safety Research Group, Department of Radiology C-2S, Leiden University Medical Center, Albinusdreef 2, NL-2333, ZA, Leiden, The Netherlands.
³ Clinical Development Department, Guerbet, Roissy CDG Cedex, France.

Abstract

Objectives: To evaluate the incidence of adverse drug reactions (ADRs), including hypersensitivity reactions (HSRs) and post-contrast acute kidney injury (PC-AKI), after intra-arterial (IA) administration of ioversol.

Methods and materials: A systematic literature search was performed (1980-2021) and studies documenting IA use of ioversol, and reporting safety outcomes were selected. Key information on study design, patients' characteristics, indication, dose, and type of safety outcome were extracted.

Results: Twenty-eight studies (including two pediatric studies) with 8373 patients exposed to IA ioversol were selected. Studies were highly heterogenous in terms of design, PC-AKI definition, and studied population. PC-AKI incidence after coronary angiography was 7.5-21.9% in a general population, 4.0-26.4% in diabetic patients, and 5.5-28.9% in patients with chronic kidney disease (CKD). PC-AKI requiring dialysis was rare and reported mainly in patients with severe CKD. No significant differences in PC-AKI rates were shown in studies comparing different iodinated contrast media (ICM). Based on seven studies of ioversol clinical development, the overall ADR incidence was 1.6%, comparable to that reported with other non-ionic ICM. Pediatric data were scarce with only one study reporting on PC-AKI incidence (12%), and one reporting on ADR incidence (0.09%), both after coronary angiography.

Conclusions: After ioversol IA administration, PC-AKI incidence was highly variable between studies, likely reflecting the heterogeneity of the included study populations, and appeared comparable to that reported with other ICM. The rate of other ADRs appears to be low. Well-designed studies are needed for a better comparison with other ICM.

Key points: • PC-AKI incidence after IA administration of ioversol appears to be comparable to that of other ICM, despite the high variability between studies. • The need for dialysis after IA administration of ioversol is rare. • No obvious difference was found regarding the safety profile of ioversol between IA and IV administration.

Keywords: Acute kidney injury; Contrast media; Drug-related side effects and adverse reactions; Injections, intra-arterial; Ioversol.

Publication types

Systematic Review

MeSH terms

Acute Kidney Injury* / chemically induced
Acute Kidney Injury* / epidemiology
Child
Contrast Media / adverse effects
Humans
Incidence
Iodine Compounds*
Renal Insufficiency, Chronic*
Risk Factors
Triiodobenzoic Acids / adverse effects

Substances

Contrast Media
Iodine Compounds
Triiodobenzoic Acids
ioversol