title: Iso-osmolality versus low-osmolality iodinated contrast medium at intravenous contrast-enhanced CT: effect on kidney function.
abstract: OBJECTIVE
  To determine the effects of iso-osmolality contrast medium compared with a low-osmolality agent on renal function (serum creatinine [SCr] and glomerular filtration rate [GFR]) in high-risk patients undergoing intravenous contrast material-enhanced CT.
  
  
  METHODS
  This HIPAA-compliant study was IRB-approved; formal consent was obtained. One hundred seventeen patients (83 men, 34 women; mean age, 64.3 years; range, 18-86 years) with decreased renal function underwent contrast-enhanced CT with either iso-osmolality iodixanol (n = 61) or low-osmolality iopromide (n = 56). Outcome measures were of SCr increase or GFR decrease for 3 days after CT, a SCr increase (of >or=0.5 mg/dL [44.2 micromol/L, 25%] or >or=1.0 mg/dL [88.4 micromol/L, 50%]), a GFR reduction (of >or=5 mL/min), and patient outcome at 30- and 90-day follow-up.
  
  
  RESULTS
  Iodixanol decreased SCr (mean +/- standard deviation) from 1.77 mg/dL +/- 0.24 (156.47 micromol/L +/- 21.22) at baseline to 1.65 mg/dL +/- 0.35 (145.86 micromol/L +/- 30.94, P = .046) at day 1, 1.73 mg/dL +/- 0.53 (152.93 micromol/L +/- 46.85, not significant) at day 2, and 1.73 mg/dL +/- 0.55 (152.93 micromol/L +/- 48.62, not significant) at day 3 (not significant). Iopromide increased SCr from 1.75 mg/dL +/- 0.32 (154.7 micromol/L +/- 28.29) at baseline to 1.8 mg/dL +/- 0.42 (159.12 micromol/L +/- 15.59) at day 1, 1.77 mg/dL +/- 0.49 (156.47 micromol/L +/- 43.32) at day 2, and 1.77 mg/dL +/- 0.62 (156.47 micromol/L +/- 54.81) at day 3 (not significant). Iodixanol increased and iopromide decreased GFR on all 3 days after CT (not significant). Fewer patients in the iodixanol group (8.5%) than in the iopromide group (27.8%) had SCr increase 0.5 mg/dL or higher (>or=25%, P = .012). Two patients in each group had SCr increase of 1.0 mg/dL or more (not significant). More patients in the iopromide group (42.3%) than in the iodoxanol group (24.1%) had a GFR reduction of 5 mL/min or higher (P = .0426). No patient had a contrast material-related adverse event at 30- or 90-day follow-up.
  
  
  CONCLUSIONS
  Intravenous contrast material application in high-risk patients is unlikely to be associated with permanent adverse outcomes. SCr levels after contrast material administration are lower in iodixanol than iopromide groups.
authors.affiliation: Department of Radiology, Medical University of South Carolina, PO Box 250322, 169 Ashley Ave, Charleston, SC 29425, USA.
authors.forename: Shaun A
authors.initials: SA
authors.lastname: Nguyen
authors.forename: Pal
authors.initials: P
authors.lastname: Suranyi
authors.forename: James G
authors.initials: JG
authors.lastname: Ravenel
authors.forename: Patrick K
authors.initials: PK
authors.lastname: Randall
authors.forename: Peter B
authors.initials: PB
authors.lastname: Romano
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Strom
authors.forename: Philip
authors.initials: P
authors.lastname: Costello
authors.forename: U Joseph
authors.initials: UJ
authors.lastname: Schoepf
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media / Q000009:adverse effects; D003404:Creatinine / Q000097:blood*; D005260:Female; D005919:Glomerular Filtration Rate / Q000187:drug effects*; D006801:Humans; D007472:Iohexol / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000737:chemistry; D007674:Kidney Diseases / Q000097:blood* / Q000139:chemically induced / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D009994:Osmolar Concentration; D011859:Radiography; D014283:Triiodobenzoic Acids / Q000008:administration & dosage / Q000009:adverse effects* / Q000737:chemistry
chemical_list: D003287:Contrast Media; D014283:Triiodobenzoic Acids; D007472:Iohexol; C038192:iopromide; D003404:Creatinine; C044834:iodixanol