Iodixanol versus iopromide in patients with renal insufficiency undergoing coronary angiography with or without PCI

Zhang, Junyi; Jiang, Yufeng; Qu, Rui; Chen, Min; Zhang, Nannan; Yang, Hua-Jia; Zhou, Yafeng

doi:10.1097/md.0000000000010617

Cited by 16 publications

(11 citation statements)

References 51 publications

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“…IOCM has osmolality similar to that of plasma, but it has a higher viscosity, which can limit the benefits from lowering the osmolality compared with LOCM. Results comparing the risk of CIN after using LOCM and IOCM have been controversial [ 38 , 39 , 40 , 41 ]. A meta-analysis comparing the risk of CIN between iodixanol (IOCM) and iopromide (LOCM) in eight randomized controlled trials (RCTs) with 3532 patients undergoing coronary angiography (CAG) with or without percutaneous coronary intervention (PCI) found no significant difference in the incidence of CIN, but adverse cardiovascular events were significantly fewer in the iodixanol group than the iopromide group [ 41 ].…”

Section: Risk Factorsmentioning

confidence: 99%

The Pathophysiology and the Management of Radiocontrast-Induced Nephropathy

Cho

2022

Diagnostics

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Contrast-induced nephropathy (CIN) is an impairment of renal function that occurs after the administration of an iodinated contrast medium (CM). Kidney dysfunction in CIN is considered transient and reversible in most cases. However, it is the third most common cause of hospital-acquired acute kidney injury and is associated with increased morbidity and mortality, especially in high-risk patients. Diagnostic and interventional procedures that require intravascular CM are being used with increasing frequency, especially among the elderly, who can be particularly susceptible to CIN due to multiple comorbidities. Therefore, identifying the exact mechanisms of CIN and its associated risk factors is crucial not only to provide optimal preventive management for at-risk patients, but also to increase the feasibility of diagnostic and interventional procedure that use CM. CM induces kidney injury by impairing renal hemodynamics and increasing the generation of reactive oxygen species, in addition to direct cytotoxicity. Periprocedural hydration is the most widely accepted preventive strategy to date. Here, we review the latest research results on the pathophysiology and management of CIN.

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Section: Risk Factorsmentioning

confidence: 99%

The Pathophysiology and the Management of Radiocontrast-Induced Nephropathy

Cho

2022

Diagnostics

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“… Note: Examples of approved imaging agent target organ toxicities are summarized. Data are summarized based on these references (Murphy & Oudit, 2010; Woolen et al, 2020; J. Zhang et al, 2018) and databases (CardinalHealth, 2019; Drugs, 2020). …”

Section: Barriers and Challenges In Developmentmentioning

confidence: 99%

Challenges in the development of nanoparticle‐based imaging agents: Characterization and biology

Crist

Dasa

Liu

et al. 2020

WIREs Nanomed Nanobiotechnol

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Despite imaging agents being some of the earliest nanomedicines in clinical use, the vast majority of current research and translational activities in the nanomedicine field involves therapeutics, while imaging agents are severely underrepresented. The reasons for this lack of representation are several fold, including difficulties in synthesis and scale‐up, biocompatibility issues, lack of suitable tissue/disease selective targeting ligands and receptors, and a high bar for regulatory approval. The recent focus on immunotherapies and personalized medicine, and development of nanoparticle constructs with better tissue distribution and selectivity, provide new opportunities for nanomedicine imaging agent development. This manuscript will provide an overview of trends in imaging nanomedicine characterization and biocompatibility, and new horizons for future development. This article is categorized under: Diagnostic Tools > in vivo Nanodiagnostics and Imaging Toxicology and Regulatory Issues in Nanomedicine > Toxicology of Nanomaterials Toxicology and Regulatory Issues in Nanomedicine > Regulatory and Policy Issues in Nanomedicine

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“…15 Compared with other CM, iodixanol (iso-osmotic contrast media) was associated with less nephrotoxicity and reduced risk of cardiovascular adverse events and heat discomfort. 16–18 Therefore, the patients with normal and mild abnormal Scr levels (Scr ⩽ 177 µmol/L) before surgery were treated with iopromide (LOCM). The patients with moderately and severely abnormal Scr level (Scr > 177 µmol/L) were treated with Iodixanol.…”

Section: Methodsmentioning

confidence: 99%

Trimetazidine can prevent the occurrence of contrast-induced nephropathy after percutaneous coronary intervention in elderly patients with renal insufficiency

Zhang

et al. 2020

Perfusion

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Background: Contrast-induced nephropathy (CIN) has become a common cause of hospital-acquired acute kidney injury in elderly patients. Trimetazidine (TMZ) is a type of anti-ischemic drug developed in recent years, which can reduce the incidence of CIN. This study aimed to evaluate the efficacy of TMZ in the prevention of contrast-induced nephropathy in elderly patients with renal insufficiency undergoing percutaneous coronary intervention (PCI) and to explore the mechanism of action. Methods: A total of 310 elderly patients with renal insufficiency undergoing elective PCI were enrolled and randomly assigned to a control group (n = 155, hydration only) and a TMZ group (n = 155, 20 mg thrice daily orally 24 hours before and 72 hours after PCI). The primary endpoint of the study was the incidence of CIN, which was defined as an increase of 25% or more, or an absolute increase of 0.5 mg/dL or more in serum creatinine from baseline value, at 48 to 72 hours following the exposure to contrast media (CM). Results: The incidence of CIN was significantly lower in the TMZ group than that in the control group (3.2% vs. 9.7%, p = 0.021). There was no difference regarding the incidence of major adverse events during hospitalization between the TMZ group and control group (1.9% vs. 2.6%, p = 1.000). Binary logistic regression results showed that TMZ was protective factors of CIN (OR = 0.274; 95% CI: 0.089–0.847; p = 0.025). Conclusion: Therefore, we came to the conclusion that prophylactic administration of TMZ can prevent the occurrence of CIN in elderly patients with renal insufficiency undergoing PCI and has a certain protective effect on the renal function of patients. According to the experimental results and the mechanism of TMZ on cardiomyocytes, we speculate that TMZ increases kidney glucose metabolism, reduces fatty acid oxidation, and also has a protective effect on kidney free radical damage and ischemia-reperfusion injury.

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Iodixanol versus iopromide in patients with renal insufficiency undergoing coronary angiography with or without PCI

Cited by 16 publications

References 51 publications

The Pathophysiology and the Management of Radiocontrast-Induced Nephropathy

The Pathophysiology and the Management of Radiocontrast-Induced Nephropathy

Challenges in the development of nanoparticle‐based imaging agents: Characterization and biology

Trimetazidine can prevent the occurrence of contrast-induced nephropathy after percutaneous coronary intervention in elderly patients with renal insufficiency

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