OBJECTIVES: To investigate in-hospital hemodialysis (HD), length of stay (LOS), mortality, and costs following use of low-osmolar contrast media (LOCM) in patients undergoing invasive cardiac catheterization procedures. METHODS: This retrospective analysis used the Premier Perspective™ database, which contains patient-level data. In-patient adults without prior HD who underwent invasive cardiac catheterization procedures with LOCM during 2007-2008 were studied (iohexol: n=36,118, iopamidol: n=36,089, ioversol: n=135,619). Propensity score weighted and multivariate logistic regression analyses were used. RESULTS: In-hospital HD rates were low after exposure to any of the 3 LOCM (0.9% iohexol, 1.0% iopamidol, 1.0% ioversol). Risk of HD did not differ between iopamidol and iohexol, but ioversol demonstrated increased risk of HD compared to iohexol (adjusted Odds Ratio [OR] 1.17, 95% CI 1.02-1.35) and iopamidol (adjusted OR 1.17, 95% CI 1.02-1.34). For in-hospital mortality (2.1% iohexol, 2.3% iopamidol, 1.9% ioversol), no between-group differences were statistically significant. Similarly, all-cause 30-day readmission rates (10.8% iohexol, 10.4% iopamidol, 10.6% ioversol) did not differ significantly between the groups. Contrast-induced acute kidney injury-related 30-day readmission rates were 0.2% in all 3 groups. There was no significant difference in the mean adjusted LOS between the groups (6.2-6.3 days). Iohexol was associated with a significantly lower (P<0.001) mean adjusted initial hospitalization cost ($21,591) compared with either iopamidol ($23,482) or ioversol ($23,484) and with a significantly lower (P<0.001) mean adjusted initial hospitalization cost post-procedure ($10,512) compared with either iopamidol ($11,393) or ioversol ($11,187). CONCLUSIONS: In this large cohort of hospitalized patients, in-hospital HD rates were low after invasive cardiac catheterization procedures with LOCM. The risk of HD was comparable with iohexol and iopamidol, while ioversol was associated with a significantly higher risk. While in-hospital mortality rates, LOS, and all-cause 30-day readmission rates did not differ significantly between the 3 LOCM, iohexol was associated with significantly lower cost.