Experimental studies have suggested that nonionic contrast agents are less nephrotoxic than ionic contrast agents. To examine the relative nephrotoxicity of the two types of agents, we randomly assigned 443 patients to receive either iopamidol (nonionic) or diatrizoate (ionic) for cardiac catheterization. The patients were stratified into low-risk (n = 283) or high-risk (n = 160) groups, on the basis of the presence of diabetes mellitus, heart failure, or preexisting renal insufficiency (base-line serum creatinine level, greater than 133 mumol per liter). Serum and urine analyses were performed at base line and 24 and 48 hours after the infusion of contrast material. Nephrotoxicity was defined as an increase in the serum creatinine level within 48 hours of at least 44 mumol per liter. The median maximal rise in the serum creatinine level was 18 mumol per liter in both the diatrizoate group (n = 235) and the iopamidol group (n = 208) (P not significant; power to detect a difference greater than 9 mumol per liter, greater than 90 percent). Creatinine levels increased by at least 44 mumol per liter (0.5 mg per deciliter) in 10.2 percent of the patients receiving diatrizoate and 8.2 percent of the patients receiving iopamidol (P not significant). Among the high-risk patients, creatinine levels increased by at least 44 mumol per liter in 17 percent of the patients in the diatrizoate group, as compared with 15 percent of the patients in the iopamidol group (P not significant). We were unable to demonstrate a difference in the incidence of nephrotoxicity between patients receiving a non-ionic contrast agent and those receiving an ionic contrast agent.
Source Information
Division of Nephrology, Duke University Medical Center, Durham, NC 27710.
This article has been cited by other articles:
Oleinik, A., Romero, J. M., Schwab, K., Lev, M. H., Jhawar, N., Delgado Almandoz, J. E., Smith, E. E., Greenberg, S. M., Rosand, J., Goldstein, J. N.
(2009). CT Angiography for Intracerebral Hemorrhage Does Not Increase Risk of Acute Nephropathy. Stroke
40: 2393-2397
[Abstract][Full Text]
Naguib, N. N. N., Nour-Eldin, N.-E. A., Lehnert, T., Hammerstingl, R. M., Korkusuz, H., Eichler, K., Zangos, S., Vogl, T. J.
(2009). Uterine Artery Embolization: Optimization with Preprocedural Prediction of the Best Tube Angle Obliquity by Using 3D-Reconstructed Contrast-enhanced MR Angiography. Radiology
251: 788-795
[Abstract][Full Text]
Newhouse, J. H., Kho, D., Rao, Q. A., Starren, J.
(2008). Frequency of Serum Creatinine Changes in the Absence of Iodinated Contrast Material: Implications for Studies of Contrast Nephrotoxicity. Am. J. Roentgenol.
191: 376-382
[Abstract][Full Text]
Nguyen, S. A., Suranyi, P., Ravenel, J. G., Randall, P. K., Romano, P. B., Strom, K. A., Costello, P., Schoepf, U. J.
(2008). Iso-Osmolality versus Low-Osmolality Iodinated Contrast Medium at Intravenous Contrast-enhanced CT: Effect on Kidney Function. Radiology
248: 97-105
[Abstract][Full Text]
Del Duca, D., Iqbal, S., Rahme, E., Goldberg, P., de Varennes, B.
(2007). Renal Failure After Cardiac Surgery: Timing of Cardiac Catheterization and Other Perioperative Risk Factors. Ann. Thorac. Surg.
84: 1264-1271
[Abstract][Full Text]
Lee, P.-T., Chou, K.-J., Liu, C.-P., Mar, G.-Y., Chen, C.-L., Hsu, C.-Y., Fang, H.-C., Chung, H.-M.
(2007). Renal Protection for Coronary Angiography in Advanced Renal Failure Patients by Prophylactic Hemodialysis: A Randomized Controlled Trial. J Am Coll Cardiol
50: 1015-1020
[Abstract][Full Text]
Onbasili, A. O, Yeniceriglu, Y., Agaoglu, P., Karul, A., Tekten, T., Akar, H., Discigil, G.
(2007). Trimetazidine in the prevention of contrast-induced nephropathy after coronary procedures. Heart
93: 698-702
[Abstract][Full Text]
Stein, P. D., Woodard, P. K., Weg, J. G., Wakefield, T. W., Tapson, V. F., Sostman, H. D., Sos, T. A., Quinn, D. A., Leeper, K. V. Jr, Hull, R. D., Hales, C. A., Gottschalk, A., Goodman, L. R., Fowler, S. E., Buckley, J. D.
(2007). Diagnostic Pathways in Acute Pulmonary Embolism: Recommendations of the PIOPED II Investigators. Radiology
242: 15-21
[Full Text]
Pannu, N., Wiebe, N., Tonelli, M., for the Alberta Kidney Disease Network,
(2006). Prophylaxis Strategies for Contrast-Induced Nephropathy. JAMA
295: 2765-2779
[Abstract][Full Text]
Rao, Q. A., Newhouse, J. H.
(2006). Risk of Nephropathy after Intravenous Administration of Contrast Material: A Critical Literature Analysis. Radiology
239: 392-397
[Abstract][Full Text]
Tepel, M., Aspelin, P., Lameire, N.
(2006). Contrast-Induced Nephropathy: A Clinical and Evidence-Based Approach. Circulation
113: 1799-1806
[Full Text]
Goldenberg, I., Matetzky, S.
(2005). Nephropathy induced by contrast media: pathogenesis, risk factors and preventive strategies. CMAJ
172: 1461-1471
[Abstract][Full Text]
Weisbord, S. D., Palevsky, P. M.
(2005). Radiocontrast-Induced Acute Renal Failure. J Intensive Care Med
20: 63-75
[Abstract]
Gleeson, T. G., Bulugahapitiya, S.
(2004). Contrast-Induced Nephropathy. Am. J. Roentgenol.
183: 1673-1689
[Full Text]
Gupta, R., Birnbaum, Y., Uretsky, B. F.
(2004). The renal patient with coronary artery disease: Current concepts and dilemmas. J Am Coll Cardiol
44: 1343-1353
[Abstract][Full Text]
Briguori, C., Colombo, A., Airoldi, F., Violante, A., Castelli, A., Balestrieri, P., Paolo Elia, P., Golia, B., Lepore, S., Riviezzo, G., Scarpato, P., Librera, M., Focaccio, A., Ricciardelli, B.
(2004). N-acetylcysteine versus fenoldopam mesylate to prevent contrast agent-associated nephrotoxicity. J Am Coll Cardiol
44: 762-765
[Abstract][Full Text]
Briguori, C., Colombo, A., Violante, A., Balestrieri, P., Manganelli, F., Paolo Elia, P., Golia, B., Lepore, S., Riviezzo, G., Scarpato, P., Focaccio, A., Librera, M., Bonizzoni, E., Ricciardelli, B.
(2004). Standard vs double dose of N-acetylcysteine to prevent contrast agent associated nephrotoxicity. Eur Heart J
25: 206-211
[Abstract][Full Text]
Fishbane, S., Durham, J. H., Marzo, K., Rudnick, M.
(2004). N-Acetylcysteine In The Prevention Of Radiocontrast-Induced Nephropathy. J. Am. Soc. Nephrol.
15: 251-260
[Abstract][Full Text]
Gami, A. S., Garovic, V. D.
(2004). Contrast Nephropathy After Coronary Angiography. Mayo Clin Proc.
79: 211-219
[Abstract]
Mehta, R. L., Chertow, G. M.
(2003). Acute Renal Failure Definitions and Classification: Time for Change?. J. Am. Soc. Nephrol.
14: 2178-2187
[Full Text]
Aspelin, P., Aubry, P., Fransson, S.-G., Strasser, R., Willenbrock, R., Berg, K. J., the NEPHRIC Study Investigators,
(2003). Nephrotoxic Effects in High-Risk Patients Undergoing Angiography. NEJM
348: 491-499
[Abstract][Full Text]
Haight, A. E., Kaste, S. C., Goloubeva, O. G., Xiong, X. P., Bowman, L. C.
(2003). Nephrotoxicity of Iopamidol in Pediatric, Adolescent, and Young Adult Patients Who Have Undergone Allogeneic Bone Marrow Transplantation. Radiology
226: 399-404
[Abstract][Full Text]
Stamatakis, M. K.
(2002). Strategies for Treatment and Prevention of Acute Renal Failure. Journal of Pharmacy Practice
15: 392-404
[Abstract]
Briguori, C., Manganelli, F., Scarpato, P., Elia, P. P., Golia, B., Riviezzo, G., Lepore, S., Librera, M., Villari, B., Colombo, A., Ricciardelli, B.
(2002). Acetylcysteine and contrast agent-associated nephrotoxicity. J Am Coll Cardiol
40: 298-303
[Abstract][Full Text]
Rihal, C. S., Textor, S. C., Grill, D. E., Berger, P. B., Ting, H. H., Best, P. J., Singh, M., Bell, M. R., Barsness, G. W., Mathew, V., Garratt, K. N., Holmes, D. R. Jr
(2002). Incidence and Prognostic Importance of Acute Renal Failure After Percutaneous Coronary Intervention. Circulation
105: 2259-2264
[Abstract][Full Text]
Mueller, C., Buerkle, G., Buettner, H. J., Petersen, J., Perruchoud, A. P., Eriksson, U., Marsch, S., Roskamm, H.
(2002). Prevention of Contrast Media-Associated Nephropathy: Randomized Comparison of 2 Hydration Regimens in 1620 Patients Undergoing Coronary Angioplasty. Arch Intern Med
162: 329-336
[Abstract][Full Text]
Kessel, D O, Robertson, I, Patel, J V, Simpson, S, Taylor, E J
(2001). Angiographic strategies when iodinated contrast medium is undesirable. Imaging
13: 349-356
[Abstract][Full Text]
Paterson, D. I., Schwartzman, K.
(2001). Strategies Incorporating Spiral CT for the Diagnosis of Acute Pulmonary Embolism : A Cost-effectiveness Analysis. Chest
119: 1791-1800
[Abstract][Full Text]
Tombach, B., Bremer, C., Reimer, P., Kisters, K., Schaefer, R. M., Geens, V., Heindel, W.
(2001). Renal Tolerance of a Neutral Gadolinium Chelate (gadobutrol) in Patients with Chronic Renal Failure: Results of a Randomized Study. Radiology
218: 651-657
[Abstract][Full Text]
Tepel, M., van der Giet, M., Schwarzfeld, C., Laufer, U., Liermann, D., Zidek, W.
(2000). Prevention of Radiographic-Contrast-Agent-Induced Reductions in Renal Function by Acetylcysteine. NEJM
343: 180-184
[Abstract][Full Text]
Deray, G.
(1999). Nephrotoxicity of contrast media. Nephrol Dial Transplant
14: 2602-2606
[Full Text]
Carmichael, P., Carmichael, A. R
(1999). Current concepts: Atherosclerotic renal artery stenosis: from diagnosis to treatment. Postgrad. Med. J.
75: 527-536
[Abstract][Full Text]
Scanlon, P. J., Faxon, D. P., Audet, A.-M., Carabello, B., Dehmer, G. J., Eagle, K. A., Legako, R. D., Leon, D. F., Murray, J. A., Nissen, S. E., Pepine, C. J., Watson, R. M., Ritchie, J. L., Gibbons, R. J., Cheitlin, M. D., Eagle, K. A., Gardner, T. J., Garson, A. Jr, Russell, R. O. Jr, Ryan, T. J., Smith, S. C. Jr
(1999). ACC/AHA guidelines for coronary angiography: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Coronary Angiography) developed in collaboration with the Society for Cardiac Angiography and Interventions. J Am Coll Cardiol
33: 1756-1824
[Full Text]
Gilfeather, M., Yoon, H.-C., Siegelman, E. S., Axel, L., Stolpen, A. H., Shlansky-Goldberg, R. D., Baum, R. A., Soulen, M. C., Schnall, M. D.
(1999). Renal Artery Stenosis: Evaluation with Conventional Angiography versus Gadolinium-enhanced MR Angiography. Radiology
210: 367-372
[Abstract][Full Text]
Haller, C., Schick, C. S., Zorn, M., Kubler, W.
(1997). Cytotoxicity of radiocontrast agents on polarized renal epithelial cell monolayers. Cardiovasc Res
33: 655-665
[Abstract]
Schreier, D. Z., Weaver, F. A., Frankhouse, J., Papanicolaou, G., Shore, E., Yellin, A. E., Harvey, F.
(1996). A Prospective Study of Carbon Dioxide--Digital Subtraction vs Standard Contrast Arteriography in the Evaluation of the Renal Arteries. Arch Surg
131: 503-508
[Abstract]
Kellerman, P. S.
(1994). Perioperative Care of the Renal Patient. Arch Intern Med
154: 1674-1688
[Abstract]
Denys, B. G., Sudhakar Reddy, P., Urestsky, B. F.
(1991). The Use of Ionic and Nonionic Contrast Agents and the Effects of Hydration in the Post Cardiac Transplant Patient with Moderate Renal Insufficiency. ANGIOLOGY
42: 218-223
[Abstract]
Rich, M. W., Crecelius, C. A.
(1990). Incidence, Risk Factors, and Clinical Course of Acute Renal Insufficiency After Cardiac Catheterization in Patients 70 Years of Age or Older: A Prospective Study. Arch Intern Med
150: 1237-1242
[Abstract]
Redman, H. C., Miller, G. L.
(1990). Water-Soluble Radiographic Contrast Media: Ionic vs. Nonionic. PERSPECT VASC SURG ENDOVASC THER
3: 45-55
Bettmann, M. A.
(1990). Expert Commentary. PERSPECT VASC SURG ENDOVASC THER
3: 56-58
(1989). CONTRAST-DYE NEPHROPATHY: THE RISKS ARE LOWER THAN EXPECTED. JWatch General
1989: 7-7
[Full Text]
Previous
