Nephrotoxicity of ionic and nonionic contrast media in 1196 patients: A randomized trial

Abstract

The incidence of nephrotoxicity occurring with the nonionic contrast agent, iohexol, and the ionic contrast agent, meglumine/sodium diatrizoate, was compared in 1196 patients undergoing cardiac angiography in a prospective, randomized, double-blind multicenter trial. Patients were stratified into four groups: renal insufficiency (RI), diabetes mellitus (DM) both absent (N = 364); RI absent, DM present (N = 318); RI present, DM absent (N = 298); and RI and DM both present (N = 216). Serum creatinine levels were measured at -18 to 24, 0, and 24, 48, and 72 hours following contrast administration. Prophylactic hydration was administered pre- and post-angiography. Acute nephrotoxicity (increase in serum creatinine of > or = 1 mg/dl 48 to 72 hours post-contrast) was observed in 42 (7%) patients receiving diatrizoate compared to 19 (3%) patients receiving iohexol, P < 0.002. Differences in nephrotoxicity between the two contrast groups were confined to patients with RI alone or combined with DM. In a multivariate analysis, baseline serum creatinine, male gender, DM, volume of contrast agent, and RI were independently related to the risk of nephrotoxicity. Patients with RI receiving diatrizoate were 3.3 times as likely to develop acute nephrotoxicity compared to those receiving iohexol. Clinically severe adverse renal events were uncommon (N = 15) and did not differ in incidence between contrast groups (iohexol N = 6; diatrizoate N = 9). In conclusion, in patients undergoing cardiac angiography, only those with pre-existing RI alone or combined with DM are at higher risk for acute contrast nephrotoxicity.(ABSTRACT TRUNCATED AT 250 WORDS)

Gadolinium contrast media are more nephrotoxic than iodine media. The importance of osmolality in direct renal artery injections

“…Iodine-based LOCM has been shown to be less nephrotoxic than HOCM [40,41]. The LOCM iohexol in turn implied a higher risk of CIN compared with the IOCM iodixanol in a recent study on high-risk patients with a combination of decreased GFR and diabetes mellitus [42].…”

Gadolinium contrast media are more nephrotoxic than a low osmolar iodine medium employing doses with equal x-ray attenuation in renal arteriography: An experimental study in pigs1

“…There are also clinical studies (2,3,57) indicating that the use of CM causing a lower osmotic load on the kidneys will reduce the risk of the CMN in azotemic patients. When low-osmolality CM (eg, iohexol) was compared with high-osmolality CM (eg, diatrizoate) the CM representing the lower osmotic load reduced the risk of CMN (2,3).…”

“…When low-osmolality CM (eg, iohexol) was compared with high-osmolality CM (eg, diatrizoate) the CM representing the lower osmotic load reduced the risk of CMN (2,3). In a recent study comparing iohexol with the iso-osmolar iodixanol, a nonionic dimer representing an osmotic load still lower than that of iohexol, iodixanol caused less deterioration of renal function (57).…”

“…The use of low-osmolar instead of high-osmolar I-CM has reduced this risk (2,3). CMN is still a burning issue because there is a tendency to expose an increasing number of patients to larger amounts of I-CM because of the expanding use of computed tomography, angiography, and vascular interventions, which all require high doses of I-CM.…”

Radiocontrast‐induced natriuresis associated with increased urinary urodilatin excretion

“…Despite the increasing use of non-ionic radiocontrast agents with reduced hyperosmolality radiocontrast-induced nephropathy remains a major clinical problem, as older and sicker patients are being studied invasively [18]. The nephrotoxicity of radiocontrast agents is in part related to haemodynamically mediated hypoxia of the renal medulla [19].…”