Nephrotoxicity of high-osmolality versus low-osmolality contrast media: randomized clinical trial.
The comparative frequency of and risk factors for nephrotoxicity with low-osmolality contrast medium (LOM) versus high-osmolality contrast medium (HOM) were investigated. A randomized, double-blind clinical trial was conducted in patients undergoing diagnostic angiocardiography (n = 430) or contrast material-enhanced body computed tomography (CT) (n = 499). Nephrotoxicity was defined as an increase in serum creatinine level that was greater than both 33% and 0.4 mg/dL (40 mumols/L) above the baseline level within 48 hours after the radiologic procedure. The frequency of nephrotoxicity was similar in patients who received LOM versus those who received HOM: 13 of 479 (2.7%) versus 13 of 450 (2.9%), respectively (P = .87), overall; 4.4% versus 4.0% in angiocardiography patients (P = .84); and 1.2% versus 2.0% in body CT patients (P = .35). Factors associated (P less than .05) with increased risk of nephrotoxicity were insulin-dependent diabetes, baseline serum creatinine level greater than 1.5 mg/dL (130 mumols/L), concurrent use of furosemide, and angiocardiographic examination. Patients who have preexisting renal insufficiency may be at higher risk for nephrotoxicity with HOM than with LOM.
Moore
R D
RD
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205.
Steinberg
E P
EP
Powe
N R
NR
Brinker
J A
JA
Fishman
E K
EK
Graziano
S
S
Gopalan
R
R
D000790:Angiocardiography; D003287:Contrast Media / Q000633:toxicity*; D003404:Creatinine / Q000097:blood; D003974:Diatrizoate Meglumine / Q000633:toxicity; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007472:Iohexol / Q000633:toxicity; D007668:Kidney / Q000187:drug effects*; D008297:Male; D008875:Middle Aged; D009994:Osmolar Concentration; D012044:Regression Analysis; D012307:Risk Factors; D014057:Tomography, X-Ray Computed
D003287:Contrast Media; D003974:Diatrizoate Meglumine; D007472:Iohexol; D003404:Creatinine