title: Contrast-induced acute kidney injury in patients with renal dysfunction undergoing a coronary procedure and receiving non-ionic low-osmolar versus iso-osmolar contrast media.
abstract: BACKGROUND
  Although the superiority of low-osmolar over high-osmolar contrast agents in prevention of contrast-induced acute kidney injury (CI-AKI) is generally accepted, the relative nephrotoxicity of iso-osmolar over low-osmolar agents has not yet clearly defined. We examined the incidence of CI-AKI according to the type of contrast agent used in a randomized study of ascorbic acid for CI-AKI prevention.
  
  
  METHODS
  A total of 222 patients with baseline serum creatinine >or=1.2 mg/dL who were undergoing a coronary procedure and who were randomized to receive ascorbic acid or placebo were evaluated. The iso-osmolar agent iodixanol was used in 144 patients, whereas low-osmolar non-ionic agents were used in 78 patients (iomeprol, n = 40; iobitridol, n = 30; iopentol, n = 8). CI-AKI was defined by an absolute serum creatinine increase of >or=0.5 mg/dL or a relative increase of >or=25% measured 2 to 5 days after the procedure.
  
  
  RESULTS
  The groups of patients who received iso-osmolar and low-osmolar non-ionic agents were well balanced in terms of demographic, clinical, and procedural characteristics. The overall CI-AKI incidence was 14.6% for the iso-osmolar iodixanol versus 14.1% for the combined low-osmolar non-ionic agents (iomeprol, 10%; iobitridol, 10%; iopentol, 50%). For iodixanol, the incidence of CI-AKI was 7.4% for patients randomized to receive ascorbic acid and 21.6% for placebo (P = 0.02). The corresponding incidences for the low-osmolar non-ionic agents were 9.1% and 20.6%, respectively (P = 0.19).
  
  
  CONCLUSIONS
  No differences in CI-AKI incidence were apparent among patients receiving non-ionic iso-osmolar iodixanol and non-ionic low-osmolar contrast agents. The preventative effect of ascorbic acid was also similar.
authors.affiliation: Department of Cardiology, Onassis Cardiac Surgery Centre, Athens, Greece.
authors.forename: Elias
authors.initials: E
authors.lastname: Alexopoulos
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Spargias
authors.forename: Stamatis
authors.initials: S
authors.lastname: Kyrzopoulos
authors.forename: Athanassios
authors.initials: A
authors.lastname: Manginas
authors.forename: Gregory
authors.initials: G
authors.lastname: Pavlides
authors.forename: Vassilis
authors.initials: V
authors.lastname: Voudris
authors.forename: Stamatios
authors.initials: S
authors.lastname: Lerakis
authors.forename: Dalton S
authors.initials: DS
authors.lastname: McLean
authors.forename: Dennis V
authors.initials: DV
authors.lastname: Cokkinos
mesh_terms: D000208:Acute Disease; D000368:Aged; D003287:Contrast Media / Q000009:adverse effects* / Q000737:chemistry; D017023:Coronary Angiography / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007479:Iopamidol / Q000009:adverse effects / Q000031:analogs & derivatives / Q000737:chemistry; D007674:Kidney Diseases / Q000139:chemically induced* / Q000453:epidemiology* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009994:Osmolar Concentration; D014283:Triiodobenzoic Acids / Q000009:adverse effects / Q000737:chemistry
chemical_list: D003287:Contrast Media; D014283:Triiodobenzoic Acids; C057937:iomeprol; C044834:iodixanol; D007479:Iopamidol