There is no statistically significant difference between iopamidol-370 (Isovue) and iodixanol-320 (Visipaque) in the rate of contrast-induced nephropathy (CIN) in high-risk patients undergoing CT, according to a randomized trial in the July issue of the American Journal of Roentgenology.
The purpose of the prospective, randomized, double-blinded PREDICT (Patients with REnal impairment and DIabetes undergoing CT) trial was to compare nonionic monomer iopamidol-370 (Isovue-370, Bracco Diagnostics from Princeton, N.J., 796 mOsm/kg) or the nonionic dimer iodixanol-320 (Visipaque-320, GE Healthcare, 290 mOsm/kg) in patients with diabetes and chronic kidney disease undergoing CT.
Matthew J. Kuhn, MD, chief of the division of neuroradiology at Southern Illinois University School of Medicine in Springfield, Ill., and colleagues randomized 263 patients with moderate to severe chronic kidney disease (estimated glomerular filtration rate (GFR) = 20–59 mL/min/1.73 m2) and diabetes mellitus to receive at least 65 mL of iopamidol 370 or iodixanol 320 for a CT procedure.
The researchers included 248 patients in the CIN analysis: 125 receiving iopamidol 370 and 123 receiving iodixanol 320. Study population demographics were comparable, as was baseline renal function (estimated GFR = 47.6 mL/min/1.73 m 2 for the iopamidol 370 group vs. 49.9 mL/min/1.73 m 2 for the iodixanol 320 group), according to the authors.
The investigators found that increases in the serum creatinine value of ≥25 percent occurred in seven patients (5.6 percent) receiving iopamidol 370 and in six patients (4.9 percent) receiving iodixanol 320. The mean serum creatinine change from the baseline level was 0.04 mg/dL in both groups.
In patients with a baseline serum creatinine value of ≥2.0 mg/dL, baseline estimated GFR of ≤40 mL/min/1.73 m2, or those receiving >140 mL of contrast medium, the incidence of CIN was low and comparable between the two study groups, the researchers said.
“The PREDICT study reinforces the results of earlier published studies, the IMPACT Study and the CARE Study, that also failed to find a difference between iodixanol and iopamidol when administered to at-risk patients," said Kuhn.