Iso-osmolar radio contrast iodixanol in patients with chronic kidney disease.
BACKGROUND
Although radio contrast volume has been associated with worsening post-procedural kidney function, this relationship has not been extensively studied using an iso-osmolar contrast agent in chronic kidney disease patients.


METHODS
We retrospectively studied patients undergoing cardiac catheterization at the University of Minnesota from 2000 to 2004, using the iso-osmolar contrast agent, iodixanol. All patients were included who had calculated creatinine clearance (CCR) < 60 mL/min, not on dialysis, and serum creatinine measured on the same day and within 7 days after the procedure. Comparison of a subgroup with severe chronic kidney disease and diabetes mellitus was compared to a similar historical control group that used the low-osmolar contrast agent, iohexol.


RESULTS
Serum creatinine and CCR were 2.9 +/- 1.5 mg/dL and 33.4 +/- 12.0 mL/min (mean +/- standard deviation), respectively, at baseline in 117 cases. Peak creatinine increased by 0.03 +/- 0.7 mg/dL after 84.3 +/- 67.3 mL of iodixanol was used. Contrast-induced nephropathy definition was fulfilled in 22 (18.8%) cases. A non-significant negative correlation was found between the volume of iodixanol and the change in creatinine (r2 = 0.0011, p = 0.7254). A subgroup with severe chronic kidney disease and diabetes mellitus with iodixanol had a significantly lower creatinine increase (n = 25, 0.09 +/- 0.5 mg/dL), compared to historical controls (n = 42, 0.7 +/- 0.8 mg/dL) with iohexol (p < 0.001). A non-significant positive correlation between volume of contrast and change in creatinine was found in this subgroup who received iodixanol (n = 25, r2 = 0.0756, p = 0.1835), but was significant in the historical controls who received iohexol (n = 42, r2 = 0.135, p = 0.017).


CONCLUSIONS
The volume of iso-osmolar radio contrast does not affect the incidence of contrast-induced nephropathy in patients with chronic kidney disease. A randomized trial evaluating the incidence of contrast nephropathy would verify the safety of ad hoc versus staged angiographic procedures in this population.
Tadros
George M
GM
Division of Cardiovascular Diseases, University of Minnesota, 420 East Delaware Street, MMC 508, Minneapolis, MN 55455, USA. tadro0003@umn.edu
Malik
Jamil A
JA
Manske
Connie L
CL
Kasiske
Bertram L
BL
Dickinson
Stacy E
SE
Herzog
Charles A
CA
Wilson
Robert F
RF
Das
Gladwin
G
Panetta
Carmelo J
CJ
D000328:Adult; D006328:Cardiac Catheterization; D016022:Case-Control Studies; D003287:Contrast Media / Q000008:administration & dosage / Q000009:adverse effects*; D017023:Coronary Angiography; D003404:Creatinine / Q000097:blood*; D048909:Diabetes Complications / Q000097:blood; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D007472:Iohexol / Q000009:adverse effects; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000150:complications; D008297:Male; D008875:Middle Aged; D009994:Osmolar Concentration; D012189:Retrospective Studies; D014283:Triiodobenzoic Acids / Q000009:adverse effects* / Q000097:blood
D003287:Contrast Media; D014283:Triiodobenzoic Acids; D007472:Iohexol; D003404:Creatinine; C044834:iodixanol