ECR: Contrast media selection key to reducing nephrotoxicity

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The use of contrast media agent Iodixanol (Visipaque, GE Healthcare) may be an appropriate strategy for reducing the risk of contrast-induced nephropathy (CIN) in elderly patients with renal impairment undergoing coronary intervention for suspected coronary artery disease, according to a study presented during the European Congress of Radiology’s (ECR) annual conference in Vienna.

Lead author S. Wang, MD, of the department of cardiology at Shenyang General Hospital in China, and colleagues said that the findings of their study indicated that the incidence of CIN was approximately eight times lower with iodixanol than with iopromide (Ultravist, Bayer HealthCare) in their patient-population and contrast media selection is potentially more important than the volume of the agent administered.

“The role of CM osmolality as a risk factor for CIN has attracted recent attention,” said the researchers. With the aging of the world population, the burden of coronary heart disease is likely to increase. Despite technologic advances, cardiac catheterization and PCI are still associated with serious complications. CIN, resulting from the use of iodinated contrast media, is of particular concern because of its associated increased morbidity and mortality.”

Noting that while preventative measures can be taken to reduce CIN, there are many nonmodifable risk factors, including renal impairment, diabetes and older age in which clinicians must account for. The authors compared rates of CIN in elderly patients with pre-existing renal impairment after undergoing coronary intervention with iodixanol, to those undergoing the same procedure with iopromide.

The single-center, randomized study conducted at the Cardiovascular Center of Shenyang Military Command General Hospital in Shenyang, China from January 2005 through March 2006 recruited 1,708 patients age 60 and older who were renally impaired. Patients were excluded from the study if they were found to be severely renally impaired, hypersensitive to iodine-containing compounds, or if they had been administered a contrast agent within the seven days prior to the exam, wrote the authors.

The remaining 1,656 patients after exclusions were divided into two groups-one receiving iodixanol and the other, iopromide--with 828 in each cohort.

According to Wang and colleagues, the incidence of CIN was six to nine times lower with iodixanol, when compared to iopromide, independent of contrast media volume. 

“Furthermore, there was no significant difference in the incidence of CIN between iodixanol patients undergoing angiography alone (requiring a relatively small volume of contrast media) and those undergoing angiography and PCI (requiring a larger volume),” said the authors.