AHJ: Iso-osmolar contrast does not lower nephrotoxicity rate in CKD patients

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The nephrotoxicity associated with iodixanol was not significantly different from that observed with ioversol in chronic kidney disease (CKD) patients undergoing coronary angiography, according to a study in the October issue of the American Heart Journal. However, in diabetic patients, the mean peak percentage change (MPPC) was significantly lower in the iodixanol group.

Michael R. Rudnick, MD, from the University of Pennsylvania School of Medicine in Philadelphia, and colleagues compared the nephrotoxicity of iso-osmolar contrast media iodixanol (Visipaque from GE Healthcare) and the low-osmolar agent (LOCM) ioversol (Optiray from Covidien) in CKD patients undergoing coronary angiography.

The researchers conducted a prospective double-blind trial in 337 patients with stable CKD, who were randomly assigned to receive iodixanol or ioversol.

The co-primary end points were the MPPC in baseline serum creatinine and the incidence of contrast-induced nephropathy (rise of >0.5 mg/dL in baseline serum creatinine within 72 hours post-contrast) for the two contrast media in the 72-hour period after contrast administration, the authors wrote.

In 299 patients with complete post–contrast media creatinine data, the investigators found that the incidence of contrast-induced nephropathy was 21.8 percent in the iodixanol subjects and 23.8 percent in the ioversol subjects. For all patients, Rudnick and colleagues found that the MPPC was 14.7 percent with iodixanol and 20 percent with ioversol.

However, the authors noted that in a subset of diabetic patients, the value was significantly lower in the iodixanol (12.9 percent) compared with the ioversol subjects (22.4 percent).