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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[Abstract][Full Text]
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186: 613-615
[Abstract][Full Text]
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[Abstract][Full Text]
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354: 379-386
[Full Text]
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[Abstract][Full Text]
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26: 1488-1493
[Abstract][Full Text]
Brinker, J. A., Davidson, C. J., Laskey, W.
(2005). Preventing in-hospital cardiac and renal complications in high-risk PCI patients. Eur Heart J Suppl
7: G13-G24
[Abstract][Full Text]
Heinrich, M. C., Kuhlmann, M. K., Grgic, A., Heckmann, M., Kramann, B., Uder, M.
(2005). Cytotoxic Effects of Ionic High-osmolar, Nonionic Monomeric, and Nonionic Iso-osmolar Dimeric Iodinated Contrast Media on Renal Tubular Cells in Vitro. Radiology
235: 843-849
[Abstract][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]
Zhang, H. L., Khilnani, N. M., Prince, M. R., Winchester, P. A., Golia, P., Veit, P., Watts, R., Wang, Y.
(2005). Diagnostic Accuracy of Time-Resolved 2D Projection MR Angiography for Symptomatic Infrapopliteal Arterial Occlusive Disease. Am. J. Roentgenol.
184: 938-947
[Abstract][Full Text]
Goodman, L. R., Gulsun, M., Nagy, P., Washington, L.
(2005). CT of Deep Venous Thrombosis and Pulmonary Embolus: Does Iso-osmolar Contrast Agent Improve Vascular Opacification?. Radiology
234: 923-928
[Abstract][Full Text]
Bedard, J. P., Blais, C., Patenaude, Y. G., Monga, E.
(2005). Pulmonary Embolism: Prospective Comparison of Iso-osmolar and Low-Osmolarity Nonionic Contrast Agents for Contrast Enhancement at CT Angiography. Radiology
234: 929-933
[Abstract][Full Text]
Gross, J. L., de Azevedo, M. J., Silveiro, S. P., Canani, L. H., Caramori, M. L., Zelmanovitz, T.
(2005). Diabetic Nephropathy: Diagnosis, Prevention, and Treatment. Diabetes Care
28: 164-176
[Abstract][Full Text]
Gleeson, T. G., Bulugahapitiya, S.
(2004). Contrast-Induced Nephropathy. Am. J. Roentgenol.
183: 1673-1689
[Full Text]
Asif, A., Epstein, D. L., Epstein, M.
(2004). Dopamine-1 Receptor Agonist: Renal Effects and Its Potential Role in the Management of Radiocontrast-Induced Nephropathy. J Clin Pharmacol
44: 1342-1351
[Abstract][Full Text]
Maeder, M., Klein, M., Fehr, T., Rickli, H.
(2004). Contrast nephropathy: Review focusing on prevention. J Am Coll Cardiol
44: 1763-1771
[Abstract][Full Text]
Spargias, K., Alexopoulos, E., Kyrzopoulos, S., Iacovis, P., Greenwood, D. C., Manginas, A., Voudris, V., Pavlides, G., Buller, C. E., Kremastinos, D., Cokkinos, D. V.
(2004). Ascorbic Acid Prevents Contrast-Mediated Nephropathy in Patients With Renal Dysfunction Undergoing Coronary Angiography or Intervention. Circulation
110: 2837-2842
[Abstract][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]
Bettmann, M. A.
(2004). Frequently Asked Questions: Iodinated Contrast Agents. RadioGraphics
24: S3-S10
[Abstract][Full Text]
Messiou, C, Chalmers, A G
(2004). Imaging in acute pancreatitis. Imaging
16: 314-322
[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]
Roditi, G H, Harold, G
(2004). Magnetic resonance angiography and computed tomography angiography for peripheral arterial disease. Imaging
16: 205-229
[Abstract][Full Text]
Gradinscak, D. J., Young, N., Jones, Y., O'Neil, D., Sindhusake, D.
(2004). Risks of Outpatient Angiography and Interventional Procedures: A Prospective Study. Am. J. Roentgenol.
183: 377-381
[Abstract][Full Text]
Michel, S. J., Fried, A. M., Sinha, S., Willson, J., Bensadoun, E., Arnold, S., Buck, J. L.
(2004). Comparison of Iodixanol with Iohexol for Delayed Pelvic Venous Opacification: A Preliminary Study of Potential Use for CT Venography. Am. J. Roentgenol.
183: 123-126
[Abstract][Full Text]
Koneth, I., Weishaupt, D., Bachli, E. B.
(2004). Persistent nephrogram after administration of an isoosmolar contrast medium. Nephrol Dial Transplant
19: 1654-1655
[Full Text]
Bettmann, M. A., Dake, M. D., Hopkins, L. N., Katzen, B. T., White, C. J., Eisenhauer, A. C., Pearce, W. H., Rosenfield, K. A., Smalling, R. W., Sos, T. A., Venbrux, A. C.
(2004). Atherosclerotic Vascular Disease Conference: Writing Group VI: Revascularization. Circulation
109: 2643-2650
[Full Text]
Merten, G. J., Burgess, W. P., Gray, L. V., Holleman, J. H., Roush, T. S., Kowalchuk, G. J., Bersin, R. M., Van Moore, A., Simonton, C. A. III, Rittase, R. A., Norton, H. J., Kennedy, T. P.
(2004). Prevention of Contrast-Induced Nephropathy With Sodium Bicarbonate: A Randomized Controlled Trial. JAMA
291: 2328-2334
[Abstract][Full Text]
Cox, C. D., Tsikouris, J. P.
(2004). Preventing Contrast Nephropathy: What Is the Best Strategy? A Review of the Literature. J Clin Pharmacol
44: 327-337
[Abstract][Full Text]
O'Neill, W. W., Dixon, S. R.
(2004). The year in interventional cardiology. J Am Coll Cardiol
43: 875-890
[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]
Baker, C. S. R., Johnston, A., Baker, L. R. I., Knight, C. J.
(2003). Reply. J Am Coll Cardiol
42: 2169-2170
[Full Text]
Thomsen, H. S.
(2003). Guidelines for Contrast Media from the European Society of Urogenital Radiology. Am. J. Roentgenol.
181: 1463-1471
[Full Text]
Stone, G. W., McCullough, P. A., Tumlin, J. A., Lepor, N. E., Madyoon, H., Murray, P., Wang, A., Chu, A. A., Schaer, G. L., Stevens, M., Wilensky, R. L., O'Neill, W. W.
(2003). Fenoldopam Mesylate for the Prevention of Contrast-Induced Nephropathy: A Randomized Controlled Trial. JAMA
290: 2284-2291
[Abstract][Full Text]
Herzog, C. A.
(2003). How to Manage the Renal Patient with Coronary Heart Disease: The Agony and the Ecstasy of Opinion-Based Medicine. J. Am. Soc. Nephrol.
14: 2556-2572
[Full Text]
Thomsen, H S, Morcos, S K
(2003). Contrast media and the kidney: European Society of Urogenital Radiology (ESUR) Guidelines. Br. J. Radiol.
76: 513-518
[Abstract][Full Text]
Levine, G. N., Kern, M. J., Berger, P. B., Brown, D. L., Klein, L. W., Kereiakes, D. J., Sanborn, T. A., Jacobs, A. K., for the American Heart Association Diagnostic and,
(2003). Management of Patients Undergoing Percutaneous Coronary Revascularization. ANN INTERN MED
139: 123-136
[Abstract][Full Text]
Baker, C. S. R., Wragg, A., Kumar, S., De Palma, R., Baker, L. R. I., Knight, C. J.
(2003). A rapid protocol for the prevention of contrast-induced renal dysfunction: the RAPPID study. J Am Coll Cardiol
41: 2114-2118
[Abstract][Full Text]
Gruber, S. J., Shapiro, C. J., Braun, C., Birck, R., Bridges, C. M., Swaroop, V. S., Cuddihy, M.-T., Aspelin, P., Berg, K. J.
(2003). Nephropathy Induced by Contrast Medium. NEJM
348: 2257-2259
[Full Text]
Malik, I.
(2003). JournalScan. Heart
89: 582-584
[Full Text]
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