title: Extended renal outcomes with use of iodixanol versus iohexol after coronary angiography.
abstract: The impact of isoosmolar versus low-osmolar contrast media (CM) administration on contrast-induced acute kidney injury (CI-AKI) and extended renal dysfunction (ERD) is unclear. We retrospectively examined incidences of CI-AKI and ERD in patients who received iodixanol (isoosmolar) versus iohexol (low-osmolar) during angiography for cardiac indications. Of 713 patients, 560 (cohort A), 190 (cohort B), and 172 (cohort C) had serum creatinine monitored at 3 days, 30 days, and 6 months after angiography, respectively. 18% of cohort A developed CI-AKI, which was more common with iodixanol than iohexol (22% versus 13%, P = 0.006). However, patients given iodixanol were older with lower baseline estimated glomerular filtration rates (eGFR). On multivariate analysis, independent associations with higher CI-AKI risk include age >65 years, female gender, cardiac failure, ST-elevation myocardial infarction, intra-aortic balloon pump, and critical illness, but not CM type, higher CM load, or eGFR < 45 mL/min/1.73 m(2). 32% of cohort B and 34% of cohort C had ERD at 30 days and 6 months, while 44% and 41% of subcohorts had ERD at 90 days and 1 year, respectively. CI-AKI, but not CM type, was associated with medium- and longer-term ERD, with 3-fold higher risk. Advanced age, emergent cardiac conditions, and critical illness are stronger predictors of CI-AKI, compared with CM-related factors. CI-AKI predicts longer-term ERD.
authors.affiliation: Department of Intensive Care, Austin Hospital, Melbourne, VIC 3084, Australia ; Division of Nephrology, University Medicine Cluster, National University Hospital, National University Health System, Singapore 119228.
authors.forename: Horng-Ruey
authors.identifier: 0000-0003-1379-0585
authors.initials: HR
authors.lastname: Chua
authors.affiliation: Department of Cardiology, Austin Hospital, Melbourne, VIC 3084, Australia.
authors.forename: Mark
authors.initials: M
authors.lastname: Horrigan
authors.affiliation: Department of Cardiology, Austin Hospital, Melbourne, VIC 3084, Australia.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Mcintosh
authors.affiliation: Department of Intensive Care, Austin Hospital, Melbourne, VIC 3084, Australia ; Australian and New Zealand Intensive Care Research Committee (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3181, Australia.
authors.forename: Rinaldo
authors.initials: R
authors.lastname: Bellomo
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis / Q000453:epidemiology*; D017677:Age Distribution; D000368:Aged; D015331:Cohort Studies; D003287:Contrast Media; D017023:Coronary Angiography / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015994:Incidence; D007472:Iohexol; D008297:Male; D011379:Prognosis; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000453:epidemiology*; D018570:Risk Assessment; D017678:Sex Distribution; D013997:Time Factors; D014283:Triiodobenzoic Acids; D014739:Victoria / Q000453:epidemiology
chemical_list: D003287:Contrast Media; D014283:Triiodobenzoic Acids; D007472:Iohexol; C044834:iodixanol