Nephrotoxic Effects in High-Risk Patients Undergoing Angiography
Peter Aspelin, M.D., Ph.D., Pierre Aubry, M.D., Sven-Göran Fransson, M.D., Ph.D., Ruth Strasser, M.D., Ph.D., Roland Willenbrock, M.D., Knut Joachim Berg, M.D., Ph.D., for the NEPHRIC Study Investigators
Background The use of iodinated contrast medium can result innephropathy. Whether iso-osmolar contrast medium is less nephrotoxicthan low-osmolar contrast medium in high-risk patients is uncertain.
Methods We conducted a randomized, double-blind, prospective,multicenter study comparing the nephrotoxic effects of an iso-osmolar,dimeric, nonionic contrast medium, iodixanol, with those ofa low-osmolar, nonionic, monomeric contrast medium, iohexol.The study involved 129 patients with diabetes with serum creatinineconcentrations of 1.5 to 3.5 mg per deciliter who underwentcoronary or aortofemoral angiography. The primary end pointwas the peak increase from base line in the creatinine concentrationduring the three days after angiography. Other end points werean increase in the creatinine concentration of 0.5 mg per deciliteror more, an increase of 1.0 mg per deciliter or more, and achange in the creatinine concentration from day 0 to day 7.
Results The creatinine concentration increased significantlyless in patients who received iodixanol. From day 0 to day 3,the mean peak increase in creatinine was 0.13 mg per deciliterin the iodixanol group and 0.55 mg per deciliter in the iohexolgroup (P=0.001; the increase with iodixanol minus the increasewith iohexol, –0.42 mg per deciliter [95 percent confidenceinterval, –0.73 to –0.22]). Two of the 64 patientsin the iodixanol group (3 percent) had an increase in the creatinineconcentration of 0.5 mg per deciliter or more, as compared with17 of the 65 patients in the iohexol group (26 percent) (P=0.002;odds ratio for such an increase in the iodixanol group, 0.09[95 percent confidence interval, 0.02 to 0.41]). No patientreceiving iodixanol had an increase of 1.0 mg per deciliteror more, but 10 patients in the iohexol group (15 percent) did.The mean change in the creatinine concentration from day 0 today 7 was 0.07 mg per deciliter in the iodixanol group and 0.24mg per deciliter in the iohexol group (P=0.003; value in theiodixanol group minus the value in the iohexol group, –0.17mg per deciliter [95 percent confidence interval, –0.34to –0.07]).
Conclusions Nephropathy induced by contrast medium may be lesslikely to develop in high-risk patients when iodixanol is usedrather than a low-osmolar, nonionic contrast medium.
Source Information
From the Department of Radiology, Huddinge University Hospital, Stockholm, Sweden (P. Aspelin); the Department of Cardiology, Centre Hospitalier Universitaire Bichat, Paris (P. Aubry); the Department of Thoracic Radiology, Linköping University Hospital, Linköping, Sweden (S.-G.F.); the Medizinische Klinik II–Kardiologie Herzzentrum, Technische Universität, Dresden, Germany (R.S.); the Department of Cardiology, Franz-Volhard-Klinik, Helios Kliniken, Berlin, Germany (R.W.); and the Laboratory for Renal Physiology, Rikshospitalet, Oslo, Norway (K.J.B.).
Address reprint requests to Dr. Aspelin at the Department of Radiology, Huddinge University Hospital, 141 86 Stockholm, Sweden, or at peter.aspelin{at}cfss.ki.se.
Nephropathy Induced by Contrast Medium
Gruber S. J., Shapiro C. J., Braun C., Birck R., Bridges C. M., Swaroop V. S., Cuddihy M.-T., Aspelin P., Berg K. J.
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N Engl J Med 2003;
348:2257-2259, May 29, 2003.
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