Chronic Kidney Disease: Recommendations (See Table 8, and Online Data Supplement.) 6.5.1. Angiography in Patients With CKD Since the 2007 UA/NSTEMI Guidelines were published,4 several larger randomized trials have been published that reported no difference in contrast-induced nephropathy (CIN) when iodixanol was compared with various other low- osmolar contrast media (LOCM).170 173 These and other randomized trials comparing isosmolar iodixanol with LOCM have been summarized in 2 mutually supportive and complementary meta-analyses involving 16 trials in 2763 patients174 and 25 trials in 3260 patients,175 respectively. When more recent trials were combined with the older studies, the data supporting a reduction in CIN favoring iodixanol were no longer significant (summary RR: 0.79; CI: 0.61 to 1.04; P 0.10,175 respectively). However, subanal- yses showed variations in relative renal safety by specific LOCM: A reduction in CIN was observed when iodixanol was compared to ioxaglate, the only ionic LOCM (RR: 0.58; 95% CI: 0.37 to 0.92; P 0.022174), and to iohexol, a nonionic no difference was noted in comparisons of iodixanol with iopamidol, iopromide, or ioversol,174 and a single trial fa- vored iomeprol.170 A pooled comparison of iodixanol with all nonionic LOCM other than iohexol indicated equivalent Table 8. Recommendations for Chronic Kidney Disease 2012 Focused Update Recommendations 2012 Comments Class I 1. Creatinine clearance should be estimated in UA/NSTEMI patients and the doses of renally cleared medications should be adjusted according to the pharmacokinetic data for specific medications.162,163 (Level of Evidence: B) 2011 recommendation remains current. 2. Patients undergoing cardiac catheterization with receipt of contrast media should receive adequate preparatory hydration.164,165 (Level of Evidence: B) 2011 recommendation remains current. 3. 