There is no significant difference between iodixanol (Visipaque, GE Healthcare) and iopamidol (Isovue, Bracco Diagnostics) in either peak increase in serum creatinine (SCr) or risk of contrast-induced nephropathy (CIN), according to a prospective, multicenter, randomized, double-blind trial in the November issue of the American Heart Journal.
The choice of radiographic contrast media for use in patients at increased risk of CIN is of “ongoing interest,” according to the study authors.
Lead investigator Warren Laskey, MD, from the division of cardiology at the University of New Mexico School of Medicine in Albuquerque, N.M., and colleagues compared the renal effects of the non-ionic, iso-osmolal agent, iodixanol, versus the non-ionic, low-osmolal agent, iopamidol, in 526 subjects with chronic kidney disease and diabetes mellitus undergoing diagnostic and/or therapeutic coronary angiographic procedures.
The co-primary endpoints were a peak increase in SCr and an incidence of CIN (increase of at least 0.5 mg/dL) in SCr from baseline within three days of receiving contrast media.
In 418 evaluable subjects with complete post-contrast media SCr data, the researchers reported that 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.
According to the authors, the overall CIN incidence was 10.5 percent (11.2 percent in the iodixanol arm and 9.8 percent in the iopamidol arm). 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.
Laskey and colleagues found that the overall rate of CIN in patients with chronic kidney disease and diabetes mellitus undergoing coronary angiographic procedures was 10.5 percent.
Based on their findings, and contrary to the only other trial comparing contrast media--iopamidol vs. iohexol--in the same patient populations, the researchers concluded that it “may well be that there is no true difference in nephrotoxicity between iodixanol and iopamidol, or, if there is, such a difference is unlikely to be clinically meaningful.”
The authors said that further clinical trials are needed to address “even higher-risk populations (urgent/emergent procedures, poorly controlled/longstanding diabetes mellitus, creatinine clearance b30 mL/min) should carefully consider this body of prior evidence.”