Contrast-induced kidney damage can lead to stroke, MI

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Kidney injury that can arise after undergoing x-ray coronary angiography studies increases a patient's risk of having astroke or heart attack over the next year or two, according to a study in the June 25 issue of Clinical Journal of the American Society Nephrology. The findings indicate that seemingly minor and reversible kidney damage from these common clinical procedures is a serious health threat.

Exposure to contrast agents during medical imaging can injure the kidneys, but patients are often told that this is only a temporary side effect. Recent research has suggested that such contrast-induced kidney damage may actually be more serious, although no thorough studies have looked into the hypothesis.

To investigate the issue, Richard Solomon, MD, from the University of Vermont in Burlington, and his colleagues studied 294 patients with kidney disease who were exposed to contrast agents during cardiac angiography.

Patients in the CARE (Cardiac Angiography in REnally Impaired Patients) trial were randomly divided to receive one of two contrast agents: iopamidol (Isovue from Bracco Diagnostics) or iodixanol (Visipaque from GE Healthcare). After following patients for at least one year, the researchers found that 92 patients experienced negative health effects. Thirty-eight experienced a major event, such as death, stroke, heart attack, or end-stage renal disease.

The researchers concluded that individuals who developed contrast-induced kidney injuries had twice as many long-term negative health effects compared with patients whose kidneys were not damaged. In the absence of contrast-induced kidney injury, there was no difference in the incidence of long-term negative health effects between patients taking iopamidol or iodixanol.

However, the investigators found that patients taking Isovue had reduced incidences of both kidney damage and long-term negative effects. These parallel decreased incidences support the theory that contrast-induced kidney injury causes long-term negative effects.

The CARE trial findings should prompt investigators to design additional studies on the long-term negative health effects of contrast-induced kidney damage, the authors noted.

This research was funded by Bracco. Solomon is a paid consultant of Bracco.