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

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, v...

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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
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ISSN	0002-8703 1097-6744 1097-6744
DOI	10.1016/j.ahj.2009.08.016

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Abstract	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.
AbstractList	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. Background The choice of radiographic contrast media for use in patients at increased risk of contrast-induced nephropathy (CIN) is of ongoing interest. Methods 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. Results 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. Conclusions 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. The choice of radiographic contrast media for use in patients at increased risk of contrast-induced nephropathy (CIN) is of ongoing interest.BACKGROUNDThe 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 > or =0.5 mg/dL) in SCr from baseline within 3 days of receiving contrast media.METHODSThe 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 > or =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.RESULTSIn 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.CONCLUSIONSIn 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. 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 > or =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.
Author	Kumar, Sreenivas Davidson, Charles Rudnick, Michael Aubry, Pierre Laskey, Warren Gietzen, Frank Wiemer, Marcus Aspelin, Peter
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ContentType	Journal Article
Contributor	Fung, Anthony Dobrzycki, Slawomir Endresen, Knut Viswanathan, Vijay Aubry, Pierre Ratliff, Michelle McFalls, Edward O Wiemer, Marcus Kumar, Shreenivas Gietzen, Frank Schümmelfeder, Joachim Rohrbeck, Steven Sabatier, Rémi Thierfelder, Ludwig Zaman, Azfar Vrolix, Mathias Vincent, Marc Rubartelli, Paolo Kumar, Parthap Rudnick, Michael Weisbord, Steven Sack, Stefan Seshiah, V Neumann, Franz-Josef Schaer, Gary Schulze, Matthias R Acharya, Anjali Colleran, John Hirshfeld, John Manari, Antonio Tamás, Forster Goldman, Jesse Wessely, Rainer Boschat, Jacques García, Eulogio Dill, Thorsten Nishan, Peter C Bounds, Christian Knight, Charles Hanet, Claude Ibrahim, Reda Weiland, Frederick Shunk, Kendrick Buchbinder, Maurice Fernández-Avilés, Franscisco Dezsõ, Apró Willenbrock Pasierski, Tomasz Laskey, Warren Rosseel, Michael Ossei-Gerning, Nick MacDonald, Lee A Moore, Joseph Géza, Lupkovics Strasser, Ruth Jaiswal, Pramod Legrand, Victor Davidson, Charles J Richardson, J Huger Banasiak, Waldemar Aspelin, Peter Stafford, J Lawrence
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Copyright	2009 Mosby, Inc. Mosby, Inc. 2009 INIST-CNRS Copyright Elsevier Limited Nov 2009
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Issue	5
Keywords	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
Language	English
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PublicationTitle	The American heart journal
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Snippet	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... Background The choice of radiographic contrast media for use in patients at increased risk of contrast-induced nephropathy (CIN) is of ongoing interest.... The choice of radiographic contrast media for use in patients at increased risk of contrast-induced nephropathy (CIN) is of ongoing interest.BACKGROUNDThe...
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SubjectTerms	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
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Title	Nephrotoxicity of iodixanol versus iopamidol in patients with chronic kidney disease and diabetes mellitus undergoing coronary angiographic procedures
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