Cardiovascular Literature—Beyond Nephrology

Abstract

Although the occurrence of radiocontrast-induced nephropathy is relatively rare overall, approximately 2%, it is appreciable in high-risk individuals, particularly patients with chronic kidney disease (CKD) (1,2) and diabetic nephropathy (3), especially when undergoing percutaneous interventions (4) with reported rates as high as 20%. In the past, it had been reported that the isosmolar dimeric nonionic radiocontrast agent iodixanol when compared with the low osmolar monomeric nonionic agent iohexol less frequently caused radiocontrast nephropathy in high-risk patients (5). A single-center trial, however, recently failed to show a difference in the incidence of radiocontrast-induced nephropathy when iodixanol was compared with the low osmolality but ionic ioxaglate in patients with CKD (6). This issue was reexamined in this multicenter, randomized, double-blind comparison of iodixanol and iopamidol in patients who had CKD (estimated GFR [eGFR] 20 to 59 ml/min per 1.73 m2) and underwent cardiac angiography or percutaneous coronary interventions. ### Findings. A total of 482 patients could be evaluated. The two groups were comparable with respect to all relevant parameters, particularly eGFR (49.3 ± 11.6 versus 50.2 ± 13.0 ml/min per 1.73 m2). The primary end point of an increase in serum creatinine >0.5 mg/dl was not significantly different between the two groups (6.7% iodixanol versus 4.4% iopamidol). The secondary end points of a >25% increase of serum creatinine occurred in 12.4% on iodixanol versus 9.8% on iopamidol (NS) and a decrease of eGFR in 10.0% on iodixanol versus in 5.9% on iopamidol. The secondary end points of postdose increase in serum creatinine and decrease of eGFR, respectively, were even in favor of iopamidol (serum creatinine 0.07 ± 0.22 mg/dl on iopamidol versus 0.12 ± 0.23 mg/dl on iodixanol; P < 0.03) particularly in the subgroup of patients with diabetes (0.07 ± 0.26 mg/dl versus 0.16 ± 0.27; P < 0.01). …