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Iodixanol, iopamidol not linked with increased serum creatinine levels
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Neither iodixanol nor iopamidol were associated with increased serum creatinine levels or with contrast-induced nephropathy for patients with chronic kidney disease and diabetes.
Researchers enrolled 526 patients with impaired baseline renal function undergoing diagnostic and/or therapeutic coronary angiographic procedures and randomly assigned them to the non-ionic, iso-osmolal agent iodixanol (Visipaque, GE Healthcare) or the non-ionic, low-osmolal agent iopamidol (Isovue, Bracco Diagnostics). The study’s coprimary endpoints were serum creatinine levels at three days compared with baseline and the incidence of contrast-induced nephropathy from baseline to day three.
According to the researchers, complete post-contrast media serum creatinine data were available for 418 patients. The median peak increase in serum creatinine levels in the per protocol iodixanol group was 0.10 mg/dL, compared with a median increase of 0.09 mg/dL (P=.13) in the iopamidol group. The contrast-induced nephropathy rate in the iodixanol group was 11.2% and was 9.8% in the iopamidol group (P=.7). No differences in contrast-induced nephropathy were reported between patients undergoing percutaneous coronary intervention (10.5% iodixanol vs. 7.8% iopamidol; P=.13) or angiography only (8.9% iodixanol vs. 4.6% iopamidol; P=.92). The researchers also reported that the volume of saline distributed, frequency of coronary interventional procedures, volume of contrast media and severity of baseline kidney disease and diabetes were similar between the study groups.
“In the present study, a significant difference in nephrotoxicity between the iso-osmolal contrast media iodixanol and the low-osmolal contrast media iopamidol in a high-risk patient population undergoing coronary angiographic procedures could not be demonstrated,” the researchers wrote. “Future clinical trial designs to address similar questions in even higher-risk populations (urgent/emergent procedures, poorly controlled/long-standing diabetes mellitus and creatinine clearance <30 mL/minute) should carefully consider this body of prior evidence.”
Laskey W. Am Heart J. 2009;158:822-828.e3.