Nephrotoxicity of iodixanol versus iopamidol in patients with chronic kidney disease and diabetes mellitus undergoing coronary angiographic procedures

• Published in: The American heart journal Vol. 158; no. 5; pp. 822 - 828.e3
• Main Authors: Laskey, Warren, Aspelin, Peter, Davidson, Charles, Rudnick, Michael, Aubry, Pierre, Kumar, Sreenivas, Gietzen, Frank, Wiemer, Marcus
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.11.2009; Mosby; Elsevier Limited
• Subjects: Aged; Biological and medical sciences; Cardiology. Vascular system; Cardiovascular; Cardiovascular system; Contrast agents; Contrast Media - toxicity; Coronary Angiography - adverse effects; Creatinine - blood; Diabetes; Diabetes. Impaired glucose tolerance; Diabetic Nephropathies - blood; Double-Blind Method; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Female; Hospitals; Humans; Hydration; Investigative techniques, diagnostic techniques (general aspects); Iopamidol - toxicity; Kidney diseases; Kidney Failure, Chronic - blood; Kidneys; Male; Medical imaging; Medical sciences; Nephrology. Urinary tract diseases; Population; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Studies; Triiodobenzoic Acids - toxicity; Urinary system involvement in other diseases. Miscellaneous; Veterans; Endocrinopathy; Kidney disease; Human; Urinary system disease; Radiodiagnosis; Toxicity; Diabetes mellitus; Patient; Cardiovascular disease; Chronic kidney disease; Coronary arteriography; Renal failure; Iopamidol; Procedure; Circulatory system; Cardiology; Iodixanol; Comparative study
• ISSN: 0002-8703; 1097-6744; 1097-6744
• DOI: 10.1016/j.ahj.2009.08.016

The choice of radiographic contrast media for use in patients at increased risk of contrast-induced nephropathy (CIN) is of ongoing interest. The current study is a prospective, multicenter, randomized, double-blind design comparing the renal effects of the non-ionic, iso-osmolal agent, iodixanol, versus the non-ionic, low-osmolal agent, iopamidol, in 526 subjects with impaired baseline renal function (chronic kidney disease) and diabetes mellitus undergoing diagnostic and/or therapeutic coronary angiographic procedures. The co-primary end points were the peak increase in serum creatinine (SCr) and the incidence of CIN (increase ≥0.5 mg/dL) in SCr from baseline within 3 days of receiving contrast media. In 418 evaluable subjects with complete postcontrast media SCr data, the median peak increase in SCr in the iodixanol arm was 0.10 mg/dL, whereas in the iopamidol arm, the median peak increase was 0.09 mg/dL ( P = .13). The overall CIN incidence was 10.5% (11.2% % in the iodixanol arm and 9.8% in the iopamidol arm, P = .7). The volume of contrast media, volume of saline administered, frequency of coronary interventional procedures, and severity of baseline kidney disease and of diabetes mellitus were similar between treatments. In the present study, the overall rate of CIN in patients with chronic kidney disease and DM undergoing coronary angiographic procedures was 10.5%. There was no significant difference between iodixanol and iopamidol in either peak increase in SCr or risk of CIN.