Comparison of iodixanol and iohexol in patients undergoing intravenous pyelography: a prospective controlled study.
BACKGROUND
Nephropathy associated with contrast medium exposure is a well-known complication of IVP. However, it is uncertain whether iso-osmolar non-iodinated contrast medium (iodixanol) is less nephrotoxic than low-osmolar contrast medium (iohexol).


METHODS
In this single-center, double-blind, prospective study, 50 patients undergoing IVP were randomized into two groups receiving different contrast medium: iodixanol and iohexol. Patients in high risk for contrast nephropathy were included, 28 with renal insufficiency and 19 with diabetes mellitus. We compared the nephrotoxic effect (contrast nephropathy), complement and cytokines profile between the iodixanol and iohexol groups. The mean volume of contrast medium in each IVP procedure was 0.8 mL/kg.


RESULTS
The incidence of contrast nephropathy was 4 percent among all patients (one iodixanol and one iohexol). We found no significant differences in contrast nephropathy and allergic reactions between the two groups. There was no significant difference in cytokine profiles in both groups (p > 0.05).The incidence of allergic reaction was 16 percent among all patients. Twelve percent (3/25) had late reaction after iohexol exposure compared to four percent (2/25) with iodixanol (p = 1.0). One patient had severe skin rash due to late adverse reaction after iodixanol. No mortality was found.


CONCLUSIONS
New iodixanol and iohexol contrast medium for routine IVP examination are safe and have low nephrotoxicity profile, especially in elderly or high-risk patients. Iodixanol contrast medium has an increased risk to induce severe late adverse reaction compared to iohexol. Allergic reaction may be the main adverse effect after contrast medium infusion.
Chuang
Feng-Rong
FR
Division of Nephrology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Taiwan.
Chen
Te-Chuan
TC
Wang
I-Kuan
IK
Chuang
Chung-Hua
CH
Chang
Hsueh-Wen
HW
Ting-Yu Chiou
Terry
T
Cheng
Yu-Fan
YF
Lee
Wei-Ching
WC
Chen
Wen-Chieh
WC
Yang
Kuender-D
KD
Lee
Chih-Hsiung
CH
D058186:Acute Kidney Injury / Q000097:blood / Q000139:chemically induced* / Q000276:immunology / Q000517:prevention & control*; D000328:Adult; D000368:Aged; D003287:Contrast Media / Q000008:administration & dosage / Q000009:adverse effects*; D003404:Creatinine / Q000097:blood; D016207:Cytokines / Q000097:blood; D004311:Double-Blind Method; D003875:Drug Eruptions / Q000209:etiology; D004342:Drug Hypersensitivity / Q000097:blood / Q000209:etiology* / Q000276:immunology / Q000517:prevention & control; D005260:Female; D006801:Humans; D006968:Hypersensitivity, Delayed / Q000139:chemically induced; D015994:Incidence; D007275:Injections, Intravenous; D007472:Iohexol / Q000008:administration & dosage / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014283:Triiodobenzoic Acids / Q000008:administration & dosage / Q000009:adverse effects*; D014567:Urography / Q000379:methods*
D003287:Contrast Media; D016207:Cytokines; D014283:Triiodobenzoic Acids; D007472:Iohexol; D003404:Creatinine; C044834:iodixanol