TY - JOUR
T1 - Nephrotoxicity of ionic and nonionic contrast media in 1196 patients
T2 - A randomized trial
AU - Rudnick, M. R.
AU - Goldfarb, S.
AU - Wexler, L.
AU - Ludbrook, P. A.
AU - Murphy, M. J.
AU - Halpern, E. F.
AU - Hill, J. A.
AU - Winniford, M.
AU - Cohen, M. B.
AU - VanFossen, D. B.
N1 - Funding Information:
Portions of this manuscript were presented in abstract form in 1991 at the annual meeting of the American Society of Nephrology in Baltimore, The American Heart Association in Anaheim, and The Radiologic Society of North American in Chicago. This study was supported by Sanofi Winthrop Pharmaceuticals, New York, New York. The authors thank Donald 0. Castell, M.D. for his review of the manuscript and Marie Kobithen and Paula Weiss for manuscript preparation.
PY - 1995
Y1 - 1995
N2 - The incidence of nephrotoxicity occurring with the nonionic contrast agent, iohexol, and the ionic contrast agent, meglumine/sodium diatrizoate, was compared in 1196 patients undergoing cardiac angiography in a prospective, randomized, double-blind multicenter trial. Patients were stratified into four groups: renal insufficiency (RI), diabetes mellitus (DM) both absent (N = 364); RI absent, DM present (N = 318); RI present, DM absent (N= 298); and RI and DM both present (N = 216). Serum creatinine levels were measured at -18 to 24, 0, and 24, 48, and 72 hours following contrast administration. Prophylactic hydration was administered pre- and post-angiography. Acute nephrotoxicity (increase in serum creatinine of ≥1 mg/dl 48 to 72 hours post-contrast) was observed in 42 (7%) patients receiving diatrizoate compared to 19 (3%) patients receiving iohexol, P < 0.002. Differences in nephrotoxicity between the two contrast groups were confined to patients with RI alone or combined with DM. In a multivariate analysis, baseline serum creatinine, male gender, DM, volume of contrast agent, and RI were independently related to the risk of nephrotoxicity. Patients with RI receiving diatrizoate were 3.3 times as likely to develop acute nephrotoxicity compared to those receiving iohexol. Clinically severe adverse renal events were uncommon (N = 15) and did not differ in incidence between contrast groups (iohexol N = 6; diatrizoate N = 9). In conclusion, in patients undergoing cardiac angiography, only those with pre-existing RI alone or combined with DM are at higher risk for acute contrast nephrotoxicity. The incidence of acute nephrotoxicity in these high-risk patients is significantly less with the nonionic contrast media iohexol compared to the ionic contrast agent diatrizoate.
AB - The incidence of nephrotoxicity occurring with the nonionic contrast agent, iohexol, and the ionic contrast agent, meglumine/sodium diatrizoate, was compared in 1196 patients undergoing cardiac angiography in a prospective, randomized, double-blind multicenter trial. Patients were stratified into four groups: renal insufficiency (RI), diabetes mellitus (DM) both absent (N = 364); RI absent, DM present (N = 318); RI present, DM absent (N= 298); and RI and DM both present (N = 216). Serum creatinine levels were measured at -18 to 24, 0, and 24, 48, and 72 hours following contrast administration. Prophylactic hydration was administered pre- and post-angiography. Acute nephrotoxicity (increase in serum creatinine of ≥1 mg/dl 48 to 72 hours post-contrast) was observed in 42 (7%) patients receiving diatrizoate compared to 19 (3%) patients receiving iohexol, P < 0.002. Differences in nephrotoxicity between the two contrast groups were confined to patients with RI alone or combined with DM. In a multivariate analysis, baseline serum creatinine, male gender, DM, volume of contrast agent, and RI were independently related to the risk of nephrotoxicity. Patients with RI receiving diatrizoate were 3.3 times as likely to develop acute nephrotoxicity compared to those receiving iohexol. Clinically severe adverse renal events were uncommon (N = 15) and did not differ in incidence between contrast groups (iohexol N = 6; diatrizoate N = 9). In conclusion, in patients undergoing cardiac angiography, only those with pre-existing RI alone or combined with DM are at higher risk for acute contrast nephrotoxicity. The incidence of acute nephrotoxicity in these high-risk patients is significantly less with the nonionic contrast media iohexol compared to the ionic contrast agent diatrizoate.
UR - http://www.scopus.com/inward/record.url?scp=0028936849&partnerID=8YFLogxK
U2 - 10.1038/ki.1995.32
DO - 10.1038/ki.1995.32
M3 - Article
C2 - 7731155
AN - SCOPUS:0028936849
SN - 0085-2538
VL - 47
SP - 254
EP - 261
JO - Kidney International
JF - Kidney International
IS - 1
ER -