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

Received 17 May 2009; accepted 15 August 2009.

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.

a Department of Medicine, Division of Cardiology, University of New Mexico School of Medicine, Albuquerque, NM

b Division of Radiology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden

c Department of Medicine, Division of Cardiology, Northwestern University School of Medicine, Chicago, IL

d Division of Nephrology, University of Pennsylvania School of Medicine, Philadelphia, PA

e Department of Cardiology, Centre Hospitalier Universitaire Bichat, Paris, France

f CARE Hospital, Andhra, India

g Herz-und Gefass-Klinik Gmbh, Saale, Germany

h Herz-und Diabeteszentrum Nordhein-Westfalen, Kardiologishe Klinik, Bad Oyenhausen, Germany

Reprint requests: Warren K. Laskey, MD, Division of Cardiology, Department of Medicine, MSC10-5550, 1 University of New Mexico, Albuquerque, NM 87131.

Trial registration at clinicaltrials.gov: NCT00209430.

WL, PA, CD, MR, and PA have each received honoraria or research grant support from GE Healthcare, Ltd, Princeton, NJ.

PII: S0002-8703(09)00643-7

doi:10.1016/j.ahj.2009.08.016

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